Ault P, Plaza A, Paratz J
Royal Brisbane and Women's Hospital, Australia.
Royal Brisbane and Women's Hospital, Australia.
Burns. 2018 Feb;44(1):24-38. doi: 10.1016/j.burns.2017.05.006. Epub 2017 Jun 29.
Scar massage is used in burn units globally to improve functional and cosmetic outcomes of hypertrophic scarring following a burn, however, the evidence to support this therapy is unknown.
To review the literature and assess the efficacy of scar massage in hypertrophic burn scars.
MEDLINE, PubMed, Embase, CINAHL and the Cochrane Library were searched using the key words "burn", "burn injury", "thermal injury" and "scar", "hypertrophic scar" and "massage", "manipulation", "soft tissue mobilisation", "soft tissue manipulation". The articles were scored by the assessors using the Physiotherapy Evidence Database (PEDro) scale and outcome measures on range of motion (ROM), cosmesis (vascularity, pliability, height), pain scores, pruritus, and psychological measures of depression and anxiety were extracted.
Eight publications were included in the review with 258 human participants and 15 animal subjects who received scar massage following a thermal injury resulting in hypertrophic scarring. Outcome measures that demonstrated that scar massage was effective included scar thickness as measured with ultrasonography (p=0.001; g=-0.512); depression (Centre for Epidemiologic Studies - Depression [CES-D]) (p=0.031; g=-0.555); pain as measured with Visual Analogue Scale (VAS) (p=0.000; g=-1.133) and scar characteristics including vascularity (p=0.000; g=-1.837), pliability (p=0.000; g=-1.270) and scar height (p=0.000; g=-2.054). Outcome measures that trended towards significance included a decrease in pruritus (p=0.095; g=-1.157).
It appears that there is preliminary evidence to suggest that scar massage may be effective to decrease scar height, vascularity, pliability, pain, pruritus and depression in hypertrophic burns scaring. This review reflects the poor quality of evidence and lack of consistent and valid scar assessment tools. Controlled, clinical trials are needed to develop evidence-based guidelines for scar massage in hypertrophic burns scarring.
全球烧伤治疗单位都采用瘢痕按摩来改善烧伤后增生性瘢痕的功能和外观效果，然而，支持该疗法的证据尚不明确。
回顾文献并评估瘢痕按摩对增生性烧伤瘢痕的疗效。
使用关键词“烧伤”“烧伤损伤”“热损伤”以及“瘢痕”“增生性瘢痕”和“按摩”“手法治疗”“软组织松动术”“软组织手法治疗”检索MEDLINE、PubMed、Embase、CINAHL和Cochrane图书馆。评估人员使用物理治疗证据数据库（PEDro）量表对文章进行评分，并提取关于关节活动范围（ROM）、美观（血管分布、柔韧性、高度）、疼痛评分、瘙痒以及抑郁和焦虑的心理测量等结果指标。
该综述纳入了8篇出版物，其中258名人类参与者和15只动物在热损伤导致增生性瘢痕形成后接受了瘢痕按摩。表明瘢痕按摩有效的结果指标包括超声测量瘢痕厚度（p = 0.001；g = - 0.512）；抑郁（流行病学研究中心抑郁量表[CES - D]）（p = 0.031；g = - 0.555）；视觉模拟量表（VAS）测量的疼痛（p = 0.000；g = - 1.133）以及瘢痕特征，包括血管分布（p = 0.000；g = - 1.837）、柔韧性（p = 0.000；g = - 1.270）和瘢痕高度（p = 0.000；g = - 2.054）。有显著趋势的结果指标包括瘙痒减轻（p = 0.095；g = - 1.157）。
似乎有初步证据表明瘢痕按摩可能对减轻增生性烧伤瘢痕的高度、血管分布、柔韧性、疼痛、瘙痒和抑郁有效。本综述反映了证据质量较差以及缺乏一致且有效的瘢痕评估工具。需要进行对照临床试验，以制定增生性烧伤瘢痕瘢痕按摩的循证指南。
