Bordoni Bruno, Escher Allan R, Girgenti Gregory T, Tobbi Filippo, Bonanzinga Roberto
Physical Medicine and Rehabilitation, Foundation Don Carlo Gnocchi, Milan, ITA.
Anesthesiology/Pain Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA.
Cureus. 2023 Sep 7;15(9):e44815. doi: 10.7759/cureus.44815. eCollection 2023 Sep.
The skin is a complex organ, a system that influences and is influenced by the body system, with different skin layers always mechano-biologically active. In the presence of a lesion that damages the dermis, the skin undergoes sensory, morphological, and functional alterations. The subsequent adaptation is the formation of scar tissue, following distinct and overlapping biological phases. For reasons not yet fully elucidated, some healing processes lead to pathological scars, from which symptoms such as pain, itching, and functional limitations are derived. Currently, there is no gold standard treatment that fully meets the needs of different scars and can eliminate any symptoms that the patient suffers. One such treatment is manual medicine, which involves direct manual approaches to the site of injury. Reviewing the phases that allow the skin to be remodeled following an injury, this article reflects on the usefulness of resorting to these procedures, highlighting erroneous concepts on which the manual approach is based, compared to what the current literature highlights the cicatricial processes. Considering pathological scar adaptations, it would be better to follow a gentle manual approach.
皮肤是一个复杂的器官，是一个受身体系统影响并反过来影响身体系统的系统，不同的皮肤层始终具有机械生物学活性。在存在损害真皮的病变时，皮肤会经历感觉、形态和功能改变。随后的适应性变化是形成瘢痕组织，这遵循不同且相互重叠的生物学阶段。由于尚未完全阐明的原因，一些愈合过程会导致病理性瘢痕，从中产生疼痛、瘙痒和功能受限等症状。目前，没有一种能完全满足不同瘢痕需求并消除患者所遭受的任何症状的金标准治疗方法。手动医学就是这样一种治疗方法，它涉及对损伤部位进行直接的手动操作。回顾损伤后使皮肤重塑的各个阶段，本文思考采用这些操作程序的实用性，突出了与当前文献所强调的瘢痕形成过程相比，手动操作方法所基于的错误观念。考虑到病理性瘢痕的适应性变化，最好采用温和的手动操作方法。
