Hi All as you can see I had problems sending this to the group so I'll
try again...
>
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>Hi Catherine,
>
>
>Difficult but interesting questions? I have answer this in a rather
>jumbled format. My background is Burns and Plastic Surgery.
>
>Firstly scar mobilisation. Here you are faced with the challenges of
>either letting the scar potentially contract without any passive
>stretches or ROM or stretch/mobilise the scar to obtain ROM and
>encourage function.
>
>The difficulty appears to be with the 'reaction' of
>fibroblasts/myofibroblasts to the application of tension. It appears
>that invitro, following the release of tension the fibroblasts
>'contract' pulling in the collagen matrix therefore causing the scar to
>contract. This rate of contraction is more than with a 'non tension'
>matrix. This has proven difficult to demonstrate in humans though.
>
>If we extend this theory to humans it would appear that applying tension
>to a scar in the form of Physio or splintage may increase the rate of
>scar contraction. In some parts of Holland they do not apply tension to
>the scarred area at all but advocate early surgery and release if
>required, the state this gives better cosmetic results
>
>I am not quite sure what you mean by the superficial fascia over the
>scar, I wonder what kind of scars you are treating. Do you use any other
>scar management techniques to assist in softening/reducing the scar etc?
>
>Avoidance of Keloid scarring is difficult. The difference between
>hypertrophic scarring and keloid scarring is the ratio of collagen
>synthesis to degradation. In HTS you have about three times the amount
>of collagen required but with Keloid scarring the amount of collagen is
>approximately 10 times the normal amount in the skin, scar structure
>tends to be the same'ish'. Although these figures can be disputed as
>some studies have proven that collagen ratio varies in different parts
>of the body.
>
>Scar maturation varies with each individual. A 'normal' scar i.e. flat,
>pale and with few cosmetic or functional difficulties will settle down
>within six-twelve weeks (may be less).
>
>In contract hypertrophic scarring is at its most active during these
>first three months and may present as a red, hard and raised scar (if
>left to develop). Hypertrophic scarring may take about 12 to 24 months
>to fully mature and very much depends on the individual.
>
>Keloid scarring is different altogether although it may present itself
>after the initial injury you may also get a scar becoming active after
>several months. I have also had clients with spontaneous keloid scars
>with no remembered initial injuries. Treatment for keloids tends to
>take much longer, I have treated one child for up to four years with
>contact media (various types) we were still getting improvements with
>the scar (review visits every 3/6months).
>
>I hope this contributes to the discussion. I would be very interested in
>hearing any other views. I have spent a long time being challenged by
>the literature on the formation of scarring.
>
>Let the discussion continue, I look forward to any further replies.
>
>Sandi Carman
>
>
>In message <[log in to unmask]
>>, Kohlenstein, Catherine <[log in to unmask]> writes
>>What does the list think/practice about scar mobilization? When do you
>>actively mobilize a scar versus mobilizing the superficial fascia over the
>>scar? What is the research on scar maturation (time frame). What
>>precautions have to be taken to avoid formation of keloid with scar
>>mobiization?
>>
>>
>
--
Sandi
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