Abstract
Deep dermal defects can result from burns, necrotizing fasciitis and severe soft tissue trauma. Physiological scar restriction during wound healing becomes increasingly relevant in proportion to the affected area. This massively restricts the general mobility of patients. External mechanical influences (activity or immobilization in everyday life) can lead to the formation of marked scar strands and adhesions. Overloading results in a renewed inflammatory reaction and thus in further restriction. Appropriate mechanical stimuli can have a positive influence on the scar tissue. “Use determines function,” and even minimal external forces are sufficient to cause functional alignment (mechanotransduction). The first and second remarkable increases in connective tissue resistance (R1 and R2) seem to be relevant clinical indications of adequate dosage in the proliferation and remodulation phase, making it possible to counteract potential overdosage in deep dermal defects. The current state of research does not allow a direct transfer to the clinical treatment of large scars. However, the continuous clinical implementation of study results with regard to the mechanosensitivity of isolated fibroblasts, and the constant adaptation of manual techniques, has nevertheless created an evidence-base for manual scar therapy. The manual dosages are adapted to tissue physiology and to respective wound healing phases. Clinical observations show improved mobility of the affected regions and fewer relapses into the inflammatory phase due to mechanical overload.
Highlights
Depending on the rehabilitation phase, therapies for burn injuries include pneumonia and contracture prophylaxis, promotion of mobility and independence, and strength endurance training
Techniques and dosages are based on tissue physiology, wound healing phases and empirical clinical knowledge
The necessary stability of the scar tissue is ensured in this phase by myofibroblasts
Summary
Depending on the rehabilitation phase, therapies for burn injuries include pneumonia and contracture prophylaxis, promotion of mobility and independence, and strength endurance training. Techniques and dosages are based on tissue physiology, wound healing phases and empirical clinical knowledge. The fibres and cells which are responsible for high elasticity and mobility are mostly located in the dermis. For this reason, a loss of this layer leads to massive limitations (scar contractures). There are processes of wound healing which lead to a physiological restriction of the scar [1]. The question of which dosage should be applied in which wound healing phase at which intervention time is not easy to answer. The following sections highlight possible answers based on clinical considerations and empirical experience
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