Chinese General Hospital Colleges 

Bachelor of Sciences in Physical Therapy

PT SPEC LEC – MODULE 3

In the link above, it was shown the guidelines of Scar Treatments. after watching,
answer the following questions:
1. What is adherent scar?
 These are scars that developed or being stuck tightly underneath the px’s
tissue.
2. What is hypertrophic scar?
 These are scars that have raised or thick and lumpy, this usually grows
just on the wound borders, not exceeding and then it goes smaller beyond
time.
3. What are the techniques shown in the video? How is it done?
 Scar massage – It is demonstrated that the hand and fingers of the PT should be
on the ends of the scars, and then the PT should move the scar with their fingers
with the hand still being put where the scar is, dragging the adhered skin out of
place. If the skin is free, skin rolling is advised to be used by picking the adhered
spot and then proceed to rolling of the skin.
 Cupping - Suction cup is attached on the adherent scar together with ultrasound
gel, then it is used for massaging the scar by drawing up the cup and sliding it
unto the direction of the scar, this pulls the scar away from the tissue or draws
the cup away, it also helps to increase circulation in the area.
 Applying of thick sheet of silica gel – By applying this, it promotes the remodeling
of the scar tissue, helping the scar to be flat and smooth, used for 24 hours, only
to be removed when bathing.
 Electrical acupuncture – The ETPS is a modality sending mild DC electrical
current, energized by a 9-volt battery, after applying this unit, this makes the scar
tissue more pliable and softer.
 Sodium chloride iontophoresis – this method decreases the thickness of the scar
using a device it will propel or deliver sodium chloride unto the scar, but as
explained in the video scar massage is first done before proceeding into sodium
chloride iontophoresis and then provide a massage again to break out the bonds
on the scar tissue and to improve its quality.
4. Provide more manual therapy techniques that can manage wound scars. Name
the process and list down the procedure. (2 minimum, 5 maximum)
 Dry needling – Topical anesthetic is applied to the scar, then a sterile 1-2 mm
needle is inserted to the scar with a 45 degrees angle giving off a multiple
shallow puncture wounds within the border of the scar, wherein it bleeds and
stops quickly, the body heals and the collagen production happens.
 Soft tissue mobilization – this is applied with different direction or approaches:
 Parallel scar mobilization – Placing the hand/fingers on the sides of the scar and
make small parallel strokes, this is used to not disturb the scabs of the scars.
 Circle scar mobilization – Hand should be placed on the scar that is scab-free
and well-healed and then perform superficial circular motions, it should be done
gently and slowly while having breaks for deep breathing for working on the
tensed areas of the scar. You can increase the depth of the strokes overtime.
 Kinesiology tape – Cut the tape about 4 - 6 inches long, depends on the scar,
create an anchor on the one side of the scar, stretch the tape gently unto the
other side of the scar, giving off restriction but not too tight only about 25%-50%
stretching. Create a zigzag pattern with the tape, should be done diagonally and
then taped into place until the scar is covered.
 Pressure dressings – These are garments that are specifically for producing
pressure on the hypertrophic scar, it is just applied or worn on the specific area
where the scar tissue formation is situated.
 Cryotherapy – Liquid nitrogen is applied with an instrument like swab or cotton on
the scar tissue, freezing the hypertrophied scar, breaking down the scar.

5. Reflective questions:
a) What are the importance (rationale) of scar management in physical therapy
treatment?
 The scar management is important in the physical therapy treatment because
this helps the patient to return to functionality fully, because scar tissue can lead
to further or new disruption or complication for the patient such as alter the blood
circulation on the area of the scar growth, joint restriction due to the stiffness of
the skin especially when the scar is big, making the patient uncomfortable and
shy due to cosmesis problems because of the abnormal growth.
b) How will you explain the difference between scar management and massage to
your patient? 
 The difference between the two is that scar management is a broad term
wherein many techniques can be applied to the patient depending on the type of
the scar growth that occurred, and not every technique can be applied to all
sorts of scars, it has a specific importance as to why it is applied to that specific
scar type. While the massage is a specified scar management technique that
 can be applied on the scar tissue, to decrease its size or to break the scar that is
adhered to the tissue.
c) Research a case study that proved scar management in wound care treatment
effective. Explain what happened to the case. 
 TITLE: Use of self‐adherent silicone sheets in a pediatric burn patient: A case
report and instructions for use
The case study is about a 2-yr-old pediatric patient had a first- and
second-degree scald burn on the forehead, left ear, left cheek, neck, & chest,
affecting total 12% of body surface, 27 days is the required time for healing. The
prescribed management in this case are: wearing of pressure garments and
massage with silicone gel on the scars daily. On the 2 -month follow-up check-up,
the patient presents that she had developed hypertrophic and keloid scars on
the left central and lateral anterior thoracic wall, and left anterior shoulder.
They then prescribed to use a self-adherent occlusive silicone gel sheets
for 24-hrs except when bathing, the patient continued the treatment without
having any side effects and had presented improvement at the 4 th month. The
silicon gel sheets management is continuously used for 12 months and then
discontinued after. No recurrence of scars happened on the 18 th month follow-
up.
It is said that it is a unique challenge for pediatric patients to comply on
aggressive scar management therapies also some may not tolerate the side
effects. Although a less known therapy, it still makes the 24-hr of wearing self-
adherent occlusive silicone gel sheets seem easier to attain completing it due to
one-time application, removal on bathing and re-application. First researches
about the silicone-gel sheets are graded as weak due to susceptibility to bias, it
is also stated that elastic cohesive silicone bandages out perform the adhesive
silicone gel sheets in treating scars, but it is still not have been used to children.

The silicone’s exact mechanism of action is not yet really known but it is
markedly to decrease the water emission, and the losing of water in the
occluded skin, it has been also suggested it elevates the hydration resulting to a
decreased angiogenesis, development of capillary, creation of collagen, and
decrease of collagen being present, which gives benefit to the patient and also in
this case.

REFERENCE:

 Compression garments after a burn injury [Video file]. (2014, April 15). Retrieved
October 15, 2020, from https://www.youtube.com/watch?
v=XSEzmhR_cSQ&t=37s
 Cryotherapy for Treatment of Keloids. (2020, January 12). Retrieved October 15,
2020, from https://www.keloid212.com/cryotherapy-for-treatment-of-keloids/
 Eisendle, K., Pichler, M., De Luca, J., & Thuile, T. (2019). Use of self‐
adherent silicone sheets in a pediatric burn patient: A case report and
instructions for use. Pediatric Dermatology. doi:10.1111/pde.14017 Retrieved
October 15, 2020, from https://pubmed.ncbi.nlm.nih.gov/31626360/
 How to Treat Your Own Scar. (n.d.). Retrieved October 15, 2020, from
http://www.motionworkspt.com/content/how-treat-your-own-scar
 Keloid and hypertrophic scar. (n.d.). Retrieved October 15, 2020, from
https://dermnetnz.org/topics/keloids-and-hypertrophic-scar/
 Plastic Surgery Practice. (2014, February 19). Scar Be Gone. Retrieved October
15, 2020, from
https://www.plasticsurgerypractice.com/treatment-solutions/products/scar-be-
gone/
 Scars. (n.d.). Retrieved October 15, 2020, from
https://www.hopkinsmedicine.org/health/conditions-and-diseases/scars