2. Overview: Hypertrophic Scar
• Excessive scar formation after wound re-
epithelialization
• Occurs in more than 50% of patients with deep
second to third degree burns (dermis involved)
• Higher incidence in children/young adults and
dark skinned population
• More prevalent in chest, neck, lower face burns
and near joints, where tension on skin is greater.
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3. Hypertrophic Scar Relative to Healing
time-frame/Re-epithelialization
• Healing in 2 weeks = minimal to no scar
• Healing in 3 weeks = minimal to no scar
except in higher risk populaiton
• Healing in > 3 weeks = over 50% risk of
hypertrophic scar formation
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4. H.S. Characteristics
• Red/Hypererythema
• Raised above level of normal skin surface,
sometimes significantly
• Rigid, non-pliable
• Painful
• Severe Itching
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6. Scar maturation
• 4-8 weeks to full scar maturation with non-
hypertrophic healing ( first degree, superficial
second degree)
• Hypertrophic scars begin to appear 6 weeks –
3 months post-burn
• Peak between 3-6 months post-burn
• Partially resolve between 12-18 months:
softer, flatter, paling
• May take up to 2 years to completely mature
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7. Associated problems with H.S.
• Contracture formation
• Loss of ROM
• Poor cosmesis
• Hinders ability to return to normal activities
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9. What can be done??
Scar Management Goal: Control scar
hypertrophy and hasten scar maturation by
althering the physical and mechanical
properties of scar tissue
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11. Scar Massage
Benefits:
• Softens scar tissue by
increasing circulation and
freeing restrictive fibrous
bands
• Desensitizes tissue
Technique:
• In combination with
lubrication (moisturizing
cream)
• During prolongued stretch
• Hard enough to cause
blanching
• 3-6 times / day for 5-10
minute sessions
(*Patient/family education
important)
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12. Compression Therapy
• Elastic garments with ~25mmHg capillary
pressure
• Should begin within 2 weeks of skin grafting or
wound closure, ideally
• Should be worn 22-23 hrs/ day (removed only
for personal hygiene, stretching, scar
massage, and moisturizing)
• Should continue until scar matures (pale, flat,
pliable)
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