Hypertrophic scarring and pressure therapy

Abstract

INTRODUCTION HYPERTROPHIC scarring is disfiguring, disabling and constitutes a major clinical problem, yet little is known of the underlying mechanisms of formation. Certain predisposing factors have been documented and the nature and severity of the necessary skin damage is now generally accepted. In time the hypertrophic scar will resolve naturally to essentially normal scar tissue, yet during this time, which may be many years, irreversible damage may have been caused both to the body and the psyche. Prevention of hypertrophy is a primary consideration in the mid-term clinical management of patients with skin loss from bum or other agencies. Split skin cover, which is most effective, can however, lead to problems at the donor site; extensive full thickness skin loss may require multiple harvesting of the accessible donor sites and the repeated split skin grafts may lead to donor site hypertrophy. In spite of preventive measures patients frequently present with hypertrophic scars which demand aggressive management techniques to achieve the resolution necessary to prevent permanent disability. Without a clear understanding of the underlying mechanisms neither unequivocal prognosis nor logical therapy can be soundly based. Indeed, pressure therapy, which has been now widely accepted, owes its introduction as much to serendipity as to rational or empirical exactitude. The fact that its mode of action is disputed is in itself disquieting, yet it is the lack of adequate guidelines about the optimal or even acceptable pressure magnitudes and the necessary period of its application which is of immediate concern. An extensive series of clinical and laboratory investigations has helped to clarify the requirements of clinical management. At the same time these studies have shed some light on the mechanisms underlying both hypertrophy and pressure therapy .