We want to look at different surgical and non-surgical methods for treating a burn wound and tell you what are the ways to treat a burn wound without the need for surgery. Physicians and patients, depending on the circumstances, decide to perform one or more combination methods for these treatments. Non-surgical treatments can prevent surgery or make a large operation smaller. Non-surgical measures include applying pressure or using bandages or compression garments, creating long-term traction on the scar, using silicone coatings, massage therapy, injecting materials into the scar, cold therapy, etc. Items covered:
Pressure and compression coatings:
The use of pressure on the scar has been accepted as a treatment for many years, although there are still no carefully controlled studies on the actual effects of pressing clothing on the scar. In addition, the exact mechanism of pressure therapy and how it works is unknown. Existing theories include: 1. Helping to rearrange collagen linearly and in parallel. 2- Reduction of scar blood flow and consequently increase of collagenase activity, which causes the destruction of scar collagen. 3- Reducing inflation in the area. Destruction of fibroblasts. 5 – Reduce the synthesis and production of collagen. Recently, it has been reported in several studies that the use of pressure coatings is practically not effective in the final size of the scar.
However, the effects of pressure on scars are still widely the subject of various studies and is one of the standard clinical treatments for burn scars. Burn wounds that heal in less than 2 weeks do not require compressive treatments by treatment standards. Wounds that heal between 14 and 21 days have a higher risk. In these cases and in cases where skin grafts have been used, compressive treatment should be performed. In high-risk cases such as children, people with a history of scarring, and people with dark skin, it is best to use pressure treatments, even if the wound has healed in less than 2 weeks. This type of treatment should be started as soon as possible. In fact, it is believed that this should be done as soon as the patient’s skin can withstand the pressure of the treatment. Elastic bandages, self-adhesive grips, special gloves and other suitable bandages and splints can be used. These devices can even be used on clothing or other coverings to minimize damage to fresh skin. Pressing clothes should be used as soon as possible. These types of clothes are made ready-made by different factories and are available in various designs and sizes. Some of these clothes have soft silicone covers in their inner layer, which are designed to minimize tissue damage and help soften scars. Is . In case of unavailability, this type of cover can be sewn custom. It is best to wear these clothes permanently, except when the patient is using skin moisturizers or going to the bathroom. It is also best to use new clothes every 3 months to maintain the necessary pressure. The minimum time to wear compression garments is 6-8 months and usually for 12 to 18 months. The inner layer of compression garments is very important in terms of the performance of these garments and includes materials such as elastomer, foam, silicone gel coating, and thermoplastic. At the beginning of the work, the patient wears these clothes for a few hours a day, and this time gradually increases to 24 hours. In case of any allergy to these coatings, its use should be stopped.
Face masks :
The special shape of the face and neck makes it difficult to use the usual pressure coatings, which is why transparent and plastic masks and splints are used in these areas. Advanced forms of these masks are made in modern centers today, using laser scanning and precise design of the patient’s face by the factories that are in contact with these centers, and the therapist applies the mask when placing it on the face using heat flow. Accurately aligns with the patient’s face, and incisions are made in the eye, mouth, and nose. The mask is placed on the patient’s face in such a way that sufficient pressure is applied to the scar and then it is tightened by straps from the back so that the whitening of the scar is visible due to the pressure. The transparency of these masks allows you to see the color of the scar and the patient’s facial expressions and is more acceptable in appearance. Of course, in children, these masks can affect the anatomical growth of the face. For this reason, such children should also be under the care of an orthodontist or maxillofacial surgeon. Also, the necessary care at home and complete education of parents and patients is something that is much more important, and all these arrangements are effective when done properly at home.
Silicone is used as a sheet or gel and can be used alone or with pressure coatings. Several mechanisms have been proposed for the effect of this material, including: hydration, pressure, thermal changes, oxygen transfer and absorption of silicon material by the tissue. However, the exact mechanism of action of this substance is still unknown. Silicone coatings should be used for at least 2 months and at least 12 hours daily. The gel and skin should be thoroughly cleansed and washed and dried daily to be both effective and to prevent complications such as skin rash, itching, allergies and rubbing. Many compression garments and compression face masks have a silicone inner layer.
Use of traction and splint:
Prolonged stretching is used to increase the length of a scar that shrinks and shrinks. Applying a gentle pressure for a long time, especially on the joints, can help to correct the contraction and contraction. This is done by designing suitable splints or successive casts and machine guns, and especially in cases where the burn wound is healing, it prevents further shrinkage. This method and silicone coatings can be used simultaneously for flexion of the hands and wrists.
Soft tissue massage:
The use of massage as a non-surgical method reduces the sensitivity of the scar, reduces swelling and softens the tissue, and in some cases reduces itching. The patient can use manual or electric massage for this purpose. This operation should be done 3 to 5 times a day for 10-15 minutes.
Injection into the scar:
Injecting steroids into fresh scar tissue prevents or reduces the size of the scar. Many studies have shown that simultaneous and combination therapy can be more effective than intralesional injection with silicone or compression bandages. However, it is not possible to inject this substance into very large scars due to prescription restrictions. The injection should be started with a dose of 2.5-5 mg / ml and if tolerated and without side effects, it can be increased at later times. The injection interval is usually 3-4 weeks. Injections of FU 5 and interferon have also been less commonly used to treat contra scars, which will be discussed in other articles if needed.
Cryotherapy or cryotherapy:
Another way to scar is to use cryotherapy. It has been found that in many cases, the chilled scar begins to shrink. Of course, most colloidal scars and fewer hypertrophic ones respond to this type of treatment. One of the obstacles to this is the wounds and blisters created by this method, which make treatment of large scars difficult. Another impossibility to do it in some special places, such as the top of tendons and vital organs and the third hippopotamus, is the permanent netting of the treatment site, which does not have a favorable appearance, especially in people with dark skin.
other items :
Other things can be added to the list above, including the use of heat to make the tissue wider. Ultrasound, the use of thermal coatings and hot paraffin are examples of this. Creating tension on the contracted tissue is easier and better if it is accompanied by heating and warming the tissue.
Non-surgical treatments for scars, including pressure, traction, silicone, massage, intralesional injection, cold therapy, and heat therapy, are all accepted methods used today to treat scars. Each of these methods alone or in combination with each other, can have a great impact on improving the appearance and mood of the disease and strengthening the function of the organ, and if started in time and with proper planning, in many Eliminate the need for surgery and provide the patient with a better appearance and performance.
Dr. Hamid Norouzi