Edger-Lacoursière Zoë, Zhu Mengyue, Jean Stéphanie, Marois-Pagé Elisabeth, Nedelec Bernadette
School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada.
Hôpital de réadaptation Villa Medica, Montréal, QC, Canada.
J Burn Care Res. 2025 Aug 12;46(3):504-514. doi: 10.1093/jbcr/irae204.
Conservative management for hypertrophic scars (HSc) and scar contractures is of utmost importance to optimally reintegrate burn survivors into society. Many conservative treatment interventions have been described in the literature for the management of HSc. Recent advancements in the literature pertaining to postburn scarring and HSc formation have advanced our understanding of the mechanisms that support or refute the use of common rehabilitation treatment modalities after burn injury. This is particularly relevant for recent advancements in the fields of mechanotransduction and neurogenic inflammation, resulting in the need for rehabilitation clinicians to reflect upon commonly employed treatment interventions. The aim of this review article is to summarize and clinically apply the evidence that supports or refutes the use of common conservative treatment interventions for scar management employed after burn injury. The following treatments are discussed, and mechanotransduction and neurogenic inflammation concepts are highlighted: (1) edema management (compression, positioning/elevation, pumping exercises, retrograde massage, and manual edema mobilization); (2) pressure therapy (including custom fabricated pressure garments, inserts, face masks, and other low-load long-duration orthotic devices); (3) gels or gel sheets; (4) combined pressure therapy and gels; (5) serial casting; (6) scar massage; and (7) passive stretching. This review supports the following statements: (1) Compression for edema reduction should be initiated 48-72 hours postinjury and continued for wounds that require longer than 21 days to heal until scar maturation; (2) Elevation, pumping exercises, and retrograde massage/MEM should be used in combination with other edema management techniques; (3) Custom-fabricated pressure garments should be applied once the edema is stabilized and adequate healing has occurred. Garments should be monitored on a regular basis to ensure that optional pressure, >15 mm Hg, is maintained, adding inserts when necessary. The wearing time should be >16 hours/day; (4) Gels for postburn scar management should extend beyond the scar; (5) Serial casting should be applied when contractures interfere with function; (6) Forceful scar massage should be avoided early in the wound healing process or when the scar is inflamed or breaks down; and (7) Other treatment modalities should be prioritized over passive stretching for scar management.
肥厚性瘢痕(HSc)和瘢痕挛缩的保守治疗对于烧伤幸存者最佳地重新融入社会至关重要。文献中已描述了许多用于HSc治疗的保守治疗干预措施。有关烧伤后瘢痕形成和HSc形成的文献最新进展,加深了我们对支持或反驳烧伤后使用常见康复治疗方式的机制的理解。这对于机械转导和神经源性炎症领域的最新进展尤为重要,导致康复临床医生需要反思常用的治疗干预措施。这篇综述文章的目的是总结并临床应用支持或反驳烧伤后用于瘢痕管理的常见保守治疗干预措施的证据。讨论了以下治疗方法,并突出了机械转导和神经源性炎症概念:(1)水肿管理(压迫、体位/抬高、泵式运动、逆行按摩和手动水肿松动);(2)压力治疗(包括定制压力衣、插入物、面罩和其他低负荷长时间矫形装置);(3)凝胶或凝胶片;(4)联合压力治疗和凝胶;(5)连续石膏固定;(6)瘢痕按摩;(7)被动拉伸。本综述支持以下观点:(1)减轻水肿的压迫应在受伤后48 - 72小时开始,并持续用于愈合时间超过21天的伤口,直至瘢痕成熟;(2)抬高、泵式运动和逆行按摩/手动水肿松动应与其他水肿管理技术联合使用;(3)定制压力衣应在水肿稳定且伤口充分愈合后应用。应定期监测压力衣,以确保维持最佳压力>15 mmHg,必要时添加插入物。佩戴时间应>16小时/天;(4)用于烧伤后瘢痕管理的凝胶应超出瘢痕范围;(5)当挛缩影响功能时应应用连续石膏固定;(6)在伤口愈合早期或瘢痕发炎或破溃时应避免强力瘢痕按摩;(7)在瘢痕管理中,其他治疗方式应优先于被动拉伸。
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