Wound Assesment & Wound Management

Summary: Several treatment alternative are available for scarring correction. Choosing between them will depend on the type of scarring, and the opinion of a specialist.

Click: Scar Management Options to read about the biological skin care solution we provide as the most complete and balanced natural product for all types of skin concerns.

Customers experience with our products:

I have extremely sensitive skin, but is also very dry and you product seems to help my skin find the proper balance.
N. Q., Japan

Accurate keloid assessment is essential for medical diagnosis and for starting, monitoring, and evaluating a therapeutic strategy for keloid management.

The origin and evolution of keloid development are important-is the keloid getting better or worse? A decision whether to treat will depend on:

1. Site (anatomical location of the scar)

2. Physical manifestations (pain, itching, etc)

3. Degree of functional handicap (such as joint mobility)

4. Stigma (how much is the patient disturbed?)

A standardised photograph of the scar lesion at each consultation provides a reference to evaluate effectiveness of treatment since changes appear veryslowly. The presence of a positive family history, previous abnormal scarring in the same or other body sites, low response to treatment or recurrence of scarring, certain body locations (such as the sternum), large size, prolonged inflammation, and severe symptoms are associated with abnormal scarring.

Current ways of treating problematic Scarring

A simple plan of treatment can be offered with 3 courses of action-noninvasive treatment, invasive treatment, and leave alone management. Noninvasive options include use of compression therapy (such as pressure garments with or without gel sheeting); static and dynamic splints; acrylic casts; masks and clips; application of a variety of oils, lotions, and creams; antihistamine drugs; hydrotherapy; and psychosocial assistance and advice.

We already reviewed silicon sheeting. Massage therapy is often advocated but lacks evidence of benefit. Further below we will analyze why a topical cream made with the ONLY natural substance that acts as a complete and balanced solution for the protection, repair, renewal and moisturizing of skin of a little creature that produces it and bubbles it onto its skin may bring significant improvements to those suffering from scars and a welcome product for those willing to prevent scars before surgery or before and after scar revision procedures, as it signals the body that it is being cured and doesn't need to respond by inflammaging the area.

Invasive treatments include surgical excision and resuture. Usually, revision should be considered only if the surgeon thinks that more favorable conditions for wound healing can be achieved than on the first occasion (less inflammation, better technique). Intra lesional corticosteroid injection is more used but is prone to complications (fat atrophy, dermal thinning, and pigment variations). Other treatments that have been advocated with variable results include injections of fluorouracil, interferon gamma, and bleomycin, radiotherapy, laser therapy, and cryosurgery.

Leave alone management - Most scars are best left without invasive treatment for a year to mature before any diagnosis is made. Monitoring (wait and watch) will allow further surveillance of appearance, symptoms, and psychological impact, and reassurance is also important. Some scars are best left alone in the long term. Informed, shared decision making with patients may help reduce inappropriate claims for treatment.

When such treatment options are applied to specific scar types, certain patterns can be seen:

Treatment of widespread scars is mainly by revision surgery to diminish the width of the scar. Revised scars in anatomical sites subject to excessive tissue mobility such as limbs can benefit from splinting.
Atrophic scars have been improved with chemical peels, cutaneous laser resurfacing, dermabrasion, punch excisions, and the use of soft tissue biological and alloplastic biological fillers. Some of those techniquescan be done by non-medical specialists, and we will review them further below.
It is important to know the difference between hypertrophic and keloid scars as inappropriate management can lead to recurrence and worst scars. Simple surgical excision of keloids has a 50% - 80% risk of recurrence. The combinated use of surgery with either intralesional corticosteroid injection or radiotherapy has been the mainstay of treatment. For scar contractures, surgical release with splinting, acrylic casting, and compression therapy may be required. Full thickness and split or partial thickness skin grafts and, perhaps more effectively, local and free flaps are used for reconstruction of difficult and wide scars and contractures.

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Only a medical opinion can assure an appropiate scar management. Next, learn more about the modern alternatives for an effective treatment.

Recent Research about Scar Management Options

Evaluation of keloidal scarring formation

Dunkin CS, Pleat JM, Gillespie PH, Tyler MP, Roberts AH, McGrouther DA.
Stoke Mandeville Burns and Reconstructive Surgery Research Trust, Stoke Mandeville Hospital, Aylesbury, United Kingdom.

BACKGROUND: Although there are no studies, is a well known fact that scarring and the depth of dermal injury or burn are linked. The authors tested the hypothesis that there is a critical depth beyond which a fibrous scar develops.

METHODS: A novel jig produced a wound that was deep dermal at one end and superficial dermal at the other. Pilot studies in cadaveric and ex vivo breast skin confirmed the depth of injury. Healthy volunteers had a standardized dermal wound made on the lateral aspect of the hip. Digital photography recorded the surface appearance of wound healing and scar development. High-frequency ultrasound demonstrated the depth of the healing wound and subsequent scar in vivo.

RESULTS: One hundred thirteen human subjects participated in the clinical study. Mean length of follow up was 28.6 +/- 13.2 weeks. The deep dermal end of the wound healed with a visible scar and the superficial end had no visible residual mark after week 18. The initial length of injury was 51.3 +/- 0.6 mm, which reduced to a scar of 34.9 +/- 1.0 mm at 36 weeks (corresponding areas were 196.6 +/- 7.5 mm and 92.7 +/- 9.4 mm). High-frequency ultrasound analysis showed a gradual reduction in scar thickness at the deep end and no detectable scar at the shallow end. The transition point between scar and no scar marked the threshold depth for scarring. This was calculated as 0.56 +/- 0.03 mm, or 33.1 percent of normal hip skin thickness.

CONCLUSIONS: The dermal scratch provides a well-tolerated, standardized, and reproducible wound model for investigating the healing response to dermal injury of different depths. There is a threshold depth of dermal injury at which scarring develops.