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The importance of scar massage after surgery

Whether resulting from hand surgery, trauma, or burns, scars can limit the range of motion in the hand and upper limb. In this article, we’ll explain how scars form, different types of scars, the importance of Hand Therapy after hand surgery and different techniques to reduce scar thickness.

Understanding Scar Formation

Before delving into scar massage, it’s crucial to understand how scars form. When the skin undergoes injury, whether through surgery or trauma, the body initiates a natural healing process. Initially, a wound goes through inflammation, followed by proliferation, and then, remodelling. During the remodelling phase, collagen fibres align themselves in a haphazard manner, resulting in the formation of scar tissue.

scar-repair-stages

Different Types of Scars

Scars can vary in appearance and texture depending on factors such as the cause of the injury, individual healing processes and the location of the wound. Here are the different types of scars commonly observed:

1

Normal Scars (Flat Scars)

These scars result from the natural healing process of the skin after a hand injury, hand surgery, or trauma. They typically appear flat, pale, and may gradually fade over time. Normal scars do not usually cause significant functional or aesthetic concerns.
2

Hypertrophic Scars

Hypertrophic scars are characterised by their raised appearance and may be red, pink, or purple in colour. Unlike keloid scars, hypertrophic scars remain within the boundaries of the original wound and do not extend beyond it. They can be itchy, tender, or uncomfortable and may gradually improve over time or persist indefinitely.
3

Keloid Scars

Keloid scars are a type of raised scar that extends beyond the borders of the original wound. They are characterised by their excessive growth of scar tissue, which can be thick, firm, and rubbery in texture. Keloids often appear shiny, smooth, and may range in color from pink to dark brown. Keloid scars can be more common in individuals with darker skin tones and may cause itching, pain, or discomfort.

Issues with Scars After Hand Surgery

Thick scars, particularly hypertrophic and keloid scars, can be problematic after an injury. These types of scars result from an overproduction of collagen during the wound healing process, leading to raised, thickened, and sometimes itchy or painful scar tissue. In the context of hand surgery, thick scars can limit hand function. Here are some problems associated with thick scars after hand surgery:

1

Limited Range of Motion

Thick scars can restrict the movement of adjacent joints and tissues, leading to decreased range of motion in the hand and fingers. This limitation can affect daily activities and compromise functional abilities.
2

Pain and Discomfort

Thick scars may cause pain, tenderness, or discomfort, especially during activities that involve stretching or manipulating the affected area. This pain can hinder rehabilitation efforts and reduce overall quality of life for patients.
3

Functional Impairment

In severe cases, thick scars can cause contractures, where the scar tissue contracts and tightens, pulling the surrounding tissues and joints out of their normal position. Contractures can severely impair hand function, making it difficult or impossible to perform tasks requiring fine motor skills or grip strength.
4

Appearance Concerns

Beyond functional limitations, thick scars can have a significant impact on the aesthetic appearance of the hand. Raised, discoloured scars may cause self-consciousness and affect body image, particularly in situations where the hands are prominently visible.

Scar Massage

The Role of Scar Massage

Effective scar massage relies on appropriate techniques tailored to the unique needs of each patient. Initially, therapists assess the scar’s characteristics, including its size, texture, and sensitivity. Subsequently, they may utilise various scar management techniques. Below are some examples of how scars are treated by Hand Therapists:

  • Scar Massage: applying pressure and stroking movements to the scar mobilises scar tissue to break down adhesions. Deeper pressure applied helps remodel collagen fibres and improve scar flexibility. Scar massage is often performed with the aid for vitamin E cream or silicone gel.
  • Silicone: silicone is a widely used component in scar management due to its effectiveness in improving the appearance and texture of scars. Silicone-based products come in various forms, including sheets, gels, putty and creams.
  • Compression: compression therapy involves applying pressure to scars using specialised garments, bandages, or silicone sheets. This technique has been shown to provide numerous benefits in scar healing and can be particularly effective in flattening and improving the appearance of raised scars.

How a Hand Therapist can help

Scar massage commences when the wound has closed. A Hand Therapist will provide patients with the appropriate treatment options listed above to help reduce scar thickness, improve colouration and hand function.

If the patient has had a complex upper limb injury such as burns, degloving or crush injury, resulting in multiple scars, they may require a customised garment. A Hand  Therapist is trained at measuring the fit of the garment, customised to the shape of your arm.

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