Abstract
Postburn hypertrophic scarring is a common complication in burn injuries to the hands, often associated with impaired hand function. We evaluated the effects of extracorporeal shock wave therapy (ESWT), compared to a sham stimulation therapy, on hypertrophic scars of the hand caused by burn injury and investigated its effects on hand function. This was a double-blinded, randomized, controlled trial of 48 patients with a burn to their dominant right hand. The parameters of ESWT were as follows: energy flux density, 0.05–0.30 mJ/mm2; frequency, 4 Hz; 1000 to 2000 impulses per treatment; four treatments, once a week for four weeks. The outcomes measured were as follows: a 10-point visual analogue scale pain score; Vancouver scar scale for scar vascularity, height, pliability and pigmentation; ultrasound measurement of scar thickness; Jebsen−Taylor hand function test; grip strength; Perdue pegboard test; and the Michigan hand outcomes questionnaire. The change in the score from baseline to post-treatment was compared between the two groups. ESWT improved the pain score (p = 0.001), scar thickness (p = 0.018), scar vascularity (p = 0.0015), and improved hand function (simulated card-turning, p = 0.02; picking up small objects, p = 0.004). The other measured outcomes were not different between the two groups. ESWT is effective in decreasing pain, suppressing hypertrophic scarring, and improving hand function.
Highlights
Hypertrophic scarring is a common complication after a burn
Each of the 48 patients enrolled in the study were ≥18 years old and had sustained a deep partial-thickness burn or a full thickness burn involving only the right hand, which had been treated with a split-thickness skin graft (STSG) after the thermal injury,
We evaluated the effectiveness of extracorporeal shock wave therapy (ESWT) on the hypertrophic scars of hand burns that required STSG
Summary
Hypertrophic scarring is a common complication after a burn. Hypertrophic scars result from excessive tissue formation during the wound healing process [1]. The mechanisms underlying hypertrophic scar formation include exaggerated inflammation, prolonged re-epithelialization, excessive extracellular matrix production, and reduced apoptosis [2]. Both types of hypertrophic scars, those which are raised and inflexible [3] and those which are characterized by traction on surrounding tissues, can result in functional limitations [4]. Common complications after burn injuries to the hands include decreased hand performance, sensory impairment, and scar contracture [5]. Nonsurgical treatments of postburn hypertrophic scars include intralesional corticosteroid injection, laser therapy, compression therapy, and silicone therapy. There has been increased focus on shortening the healing time and improving hand function to reduce the risk of hypertrophic scarring
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