gms | German Medical Science

28. Jahrestagung der Deutschsprachigen Arbeitsgemeinschaft für Verbrennungsbehandlung (DAV 2010)

13.01. bis 16.01.2010, Schladming, Österreich

The use of the combination of silicone and pressure in the treatment of hypertrophic scarring: evidence and practice guidelines

Meeting Abstract

  • corresponding author Carlo Colla - AZ Maastricht, Abteilung Plastische Chirurgie, Maastricht, Niederlande
  • Eric Van den Kerckhove - AZ Maastricht, Abteilung Plastische Chirurgie, Maastricht, Niederlande
  • Kim Gorissen - AZ Maastricht, Abteilung Plastische Chirurgie, Maastricht, Niederlande
  • René Vanderhulst - AZ Maastricht, Abteilung Plastische Chirurgie, Maastricht, Niederlande

DAV 2010. 28. Jahrestagung der Deutschsprachigen Arbeitsgemeinschaft für Verbrennungsbehandlung. Schladming, Österreich, 13.-16.01.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. Doc10dav44

DOI: 10.3205/10dav44, URN: urn:nbn:de:0183-10dav448

Veröffentlicht: 30. Juni 2010

© 2010 Colla et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Introduction: During the last decades the treatment of hypertrophic scars aft er burns or extensive trauma with the combination of pressure and silicone devices is wellknown and widespread accepted evidenced based intervention. Pressure garment therapy accelerates scar healing with regard to thickness [1] of the scar and silicone gelsheeting (SGS) is effective in treating erythema and pliability of scars [2], [3]. Although both strategies have proven efficient as a single modality, the combination of both has never been tested on scars of different origin including burn scars and for the complete treatment period. This study discusses the clinical results of the combination silicone and pressure compared to a control group that did not receive pressure or silicone therapy [4]. Practice guidelines are also shown per topographical area.

Material and Methods: Between 2001 and 2008 more than 1285 patients with hypertrophic scars were treated in our outpatient scar clinic(s) by our multidiscip linary team. 345 of them were treated with rigid orthoses like facemasks (and collars) , 940 of them were treated with a combination of pressure garments and silicone (gel) sheets or a custom made scar press .

From January 2003 till December 2005, 120 patients (mean age 28.2) with traumatic (18.3%) , surgical (14.2%) or burn scars (62.5%) were included in a prospective comparative stratified study. At the end of the inclusion, patient were retrospectively classified in an early (within the first five months after healing) or late (started six to nine months after healing).

Prospective assessment of the scars was done with the Minolta Chromameter for erythema and with high frequency ultrasound measurements for thickness of the scar on a monthly basis.

A linear regression model was used to assess the differences between the early and late starters of therapy and with the control group. Level of statistical significance was set on P<0.05.

Results: A sign ificant difference in erythema values (p<0.05) was observed at 9 and 12 months post healing in favor for the pressure and silicone tretated group.

There was no difference between the early and late starters of the therapy.

A mean of 7 shape adjustments was required to maintain proper fitting and efficient pressure

An average of 10 follow up clinics was required to adjust pressure. The obtained results were dependant on these adjustments of the the applications to be efficient.

(Clinical results on different anatomical sites and guidelines are shown here)

Conclusion: The combination of silicone and pressure therapy is effective in treating hypertrophic scars of different origin with regard to erythema. Also late started therapy seems to have sufficient clinical effect on erythema in order to be recommended as an Close follow up and measurement of its efficiency is mandatory to opbtain clinical results and to avoid pitfalls in the use of the therapy.


References

1.
Anzarut A, Olson J, Sing LP, et al. The effectiveness of PGT for the prevention of abnormal scarring after burn injury: a meta-analyses. J Plast Rec Aesth Surg. 2009;62(1):77-84.
2.
Mustoe et al. International clinical recommendations on scar management. Plast Recontr Surg. 2002;110(2):590-8.
3.
Mustoe et al. Evolution of silicone therapy and mechanism of action in scar management. Aesthet Plast Surg. 2008;32(1):82-92.
4.
Gorissen K, Van den Kerckhove E, Colla C, et al. Proceedings EBA Abstract book. Estoril; 2005.