Wound care

Scar management – role of dressings with Safetac®

By: Mölnlycke Health Care, January 9 2012Posted in: Wound care

Resolution of inflammation during healing minimises scar formation, whereas persistence of the primary insult results in continued inflammation and chronic healing1. Continued fibrosis in the skin leads to scarring and, potentially, disfigurement as a result of progressive deposition of matrix. The most commonly encountered scar types include hypertrophic, keloid, widened, and contracture2,3. Whatever the type, scars are disfiguring and can interfere with the normal functioning of the primary organs that they affect, e.g. the skin and its associated appendages.

Hypertrophic scars are seen in approximately 50% of wounds after surgery and more than 50% of healed deep burns4. They are generally red, raised and itchy and appear within the boundaries of wounds. Keloid scars, although somewhat similar in appearance to hypertrophic scars, generally extend beyond the borders of the original scar: they affect
all races but are 15 times more likely to occur in patients with darker skin. The incidence of keloid scars is about 10% in wounds in the high-risk groups. Contracture scars are particularly severe and usually occur as a result of losses of large areas of skin, e.g. following burn injuries and in badly aligned surgical wounds not corresponding to Langer’s lines. These scars cause the edges of the skin to pull together, affecting the adjacent muscles and tendons, thereby restricting normal movement and resulting, in some cases, in the need for z-plasty or skin grafting. Widened scars appear when surgical wounds are stretched as a result of skin tension during the healing process. They are generally pale in colour, flat, soft and symptomless, but can be aesthetically displeasing1.

Topical silicone gel sheeting has been used successfully for over 20 years to treat hypertrophic and keloid scars5 and is supported by numerous clinical evaluations and international clinical recommendations on scar management6. It has been proposed that there are two mechanisms for the effectiveness of silicone sheets in the prevention and treatment of hypertrophic scarring. Firstly, silicone sheets limit moisture loss from the skin surface and aid in hydration and secondly, the sheets do not limit the access of oxygen to the surface of the skin due to their exceptionally high permeability. This causes a localised increase in oxygen tension leading to a down-regulation of signals that stimulate growth near the skin surface thus preventing/reducing scar formation7.

Mepiform®, a soft silicone scar dressing with Safetac®, has been evaluated in a number of studies for the treatment of hypertrophic scars. Saulsberry et al8 report on four
cases where Mepiform was utilised for scar management following surgical incisions and burns. Throughout the treatment period (at least 6 months for each patient), the dressing maintained a low profile and remained in situ under a compression garment without edge roll or interfering with joint mobility. The scars, originally hyperpigmented, returned to a more normal pigmentation with a smoother and more flexible nature8. The use of Mepiform was also associated with a significant improvement in hypertrophic scars in a study involving 12 patients9. An observational study undertaken to evaluate the effectiveness of Mepiform on post-burn and other traumatic scars of both paediatric and adult patients (n=87) in an out-patient setting found that the adherence and simplicity of the application of Mepiform appear to enhance patient compliance, as well as improving scar quality and patient comfort10. These findings are also reflected in other case study evaluations of Mepiform11.

In an RCT on 11 patients with postoperative hypertrophic scars, participants were randomly allocated to treatment with Mepiform or ‘left alone’ management (Table 13). Patients treated with Mepiform showed greater and more rapid improvements than those in the ‘left alone’ group, as measured by the Vancouver Scar Scale. Commenting on their results, the authors conclude that, as Mepiform is self-adhesive and its use limits damage to the stratum corneum on removal, it gives it an added value compared with non-adhesive silicone gel dressings12. This has been further demonstrated in a case study in which the early use of Mepiform successfully prevented scarring of a severe forehead laceration5. Mepiform has also been reported to successfully treat scars after breast operations13.

References

  1. Meyer, F.J., burnand, k.g., Abisi, S. et al. Effect of collagen turnover and matrix metalloproteinase activity on healing of venous leg ulcers. Br J Surg 2008; 95: 3, 319-325.
  2. Tredget, E.E., Nedelec, b., Scott, p.g., ghahary, A. Hypertrophic scars, keloids, and contractures. The cellular and molecular basis for therapy.  Surg Clin North Am 1997; 77:3, 701-730.
  3. Clark, C. Scars: how pharmacists can help. Pharm J 2005; 275: 7370, 451-454.
  4. Chapman, T.T. Burn scar and contracture management. J Trauma 2007; 62: 6 Suppl, S8.
  5. Meuleneire, F. Using a soft silicone dressing (Mepiform) to prevent scarring in an acute traumatic wound. Wounds UK 2007; 3: 4, 134-135.
  6. Mustoe, T.A., Cooter, R.D., Gold, M.H. et al. International Advisory Panel on Scar Management. International clinical recommendations on scar management. Plast Reconstr Surg 2002; 110: 2, 560-571.
  7. Gilman, T.H. Silicone sheet for treatment and prevention of hypertrophic scar: a new proposal for the mechanism of efficacy. Wound Repair Regen 2003; 11: 3, 235-236.
  8. Saulsberry, C.M., Abney, S.b., landry, k.N. An evaluation of a new silicone dressing for the management of hypertrophic scars. Poster presentation at the 12th Symposium on Advanced Wound Care and Medical Research Forum on Wound Repair, Anaheim, California, United States of America, 1999.
  9. Middelkoop, E., Van Uhen, E., Vloemans, J. The use of Mepiform silicone dressing as treatment for hypertrophic scars. Poster presentation at the European Wound Management Association conference, Stockholm, Sweden, 2000.
  10. Cain, V.J., mcmahon, L.R., O’Donnell, F.J. et al. Effectiveness of a silicone adherent dressing on post burn scar. Poster presentation at the American Burn Association conference, Boston, United States of America, 2001.
  11. Forest-Lalande, l. Hypertrophic scar management: our experience with Mepiform dressing. Poster presentation at the 7th Annual Canadian Association of Wound Care conference, London, Ontario, Canada, 2001. hipocratico (primum non mocere); use apositos de silicona. Poster presentation at VII Simposio Nacional Úlceras por Presión y Heridas Crónicas, Tarragona, Spain, 2008.
  12. Majan, J.l. Evaluation of a self-adherent soft silicone dressing for the treatment of hypertrophic postoperative scars. J Wound Care 2006; 15: 5, 193-196.
  13. Philandrianos, C., Lavie, A., Perchenet, A.S., Magalon, G. Prise en charge des cicatrices mammaires post operatoires. Poster presentation at the 13eme Conference Nationale des Plaies et Cicatrisations, Paris, France, 2009.
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