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[libribook.com] Traumatic Scar Tissue Management 1st Edition
CHAPTER 1IntroductionWe are not just treating scars; we are treating people with scarsPamela Fitch BA, RMTIn the developed world alone, a total of 100 million people develop scars eachyear as a result of 55 million elective operations and 25 million operations aftertrauma (Sund 2000). Current statistics estimate that over 50% of postsurgicalpatients will experience scar-related complications (Diamond 2012).Millions of people worldwide are afflicted with non-fatal burn injuries. Althoughmortality and morbidity from burns have diminished significantly over the pastseveral decades, these statistics do not reflect the overall impact on the burnsurvivor and how well they carry on with their life and manage post-burndeformities, contractures and other disabilities that collectively present withaesthetic and functional considerations (Goel & Shrivastava 2010).The prevalence of occurrence, complications and sequelae associated withproblematic scars, of varying etiology, present important clinical, economic andsocial considerations.The occurrence of excessive scarring has been documented for centuries, datingback to the Smith papyrus around 1700 BC (Berman & Bieley 1995). Thedocumented use of manual techniques in the treatment of wounds can be tracedback to the 1550s; Paré, a French surgeon, administered massage to relieve jointstiffness and improve wound healing following surgery. It has also beendocumented that during the World Wars, military nurses and, sometimes, doctorsprovided massage as a component of scar treatment as a result of unplannedevents and planned trauma (surgery).
Nowadays it is common to see massage noted in medical literature, as part of therecommended postsurgical care for scars, as a means to improve wound healingoutcomes (e.g. better scar aesthetics and more pliant, less restrictive scars).However, ironically in the present day, specific protocols for the management ofscars typically do not include massage therapy (MT) and specific referrals andpatient accessibility to MT lag, presenting a paradoxical conundrum for theprofession and those who could benefit from the treatment.In part this lag falls to the responsibility of the MT profession itself. Accordingto Cho and colleagues (2014):Evidence to support the use of scar massage is inconclusive. There is muchvariability and inconsistency with regard to when treatment should beinitiated, the appropriate treatment protocol and duration, and evaluationand measurement of outcomes.In order to improve the position of MT as a viable treatment consideration withinthe spectrum of mainstream medical care, the profession needs educationalmaterials that guide the clinician’s delivery of safe and effective care in order toachieve measureable, predictive and consistent clinical outcomes. This book isintended to support this initiative and be a go-to resource for manual scar tissuemanagement, shaped to teach massage therapists how to work safely andconfidently with people with scars.
- Page 163 and 164: PerineuriumFascia surrounding/inves
- Page 165 and 166: Pitting edemaAn edematous region wh
- Page 167 and 168: Proprioceptive disinformationRecept
- Page 169 and 170: Provisional matrixDuring the early
- Page 171 and 172: Pumping techniqueA lymphatic techni
- Page 173 and 174: Referred painPain perceived at a lo
- Page 175 and 176: RetinaculaeDense fascial bands that
- Page 177 and 178: ScarMark left in various tissues or
- Page 179 and 180: Secondary lymphedemaOccurs as a res
- Page 181 and 182: Self careThose practices and activi
- Page 183 and 184: Selfcare managementResponse to sens
- Page 185 and 186: SensitizationChanges in the PNS or
- Page 187 and 188: SerotoninNeurotransmitter involved
- Page 189 and 190: Shear techniqueA therapeutic loadin
- Page 191 and 192: Skin graftMedical procedure where a
- Page 193 and 194: SomatizationA tendency to experienc
- Page 195 and 196: State anxietyThe experience of unpl
- Page 197 and 198: Stress response adaptationAny of th
- Page 199 and 200: Stress responseAny cognitive, physi
- Page 201 and 202: Substance PA neuropeptide acting as
- Page 203 and 204: Therapeutic environmentEncompasses
- Page 205 and 206: Therapeutic relationshipEncompasses
- Page 207 and 208: Trait anxietyA more intense degree
- Page 209 and 210: TraumaInsult or injury to the physi
- Page 211 and 212: Traumatic scarPathophysiological sc
- Page 213: ViscoelasticityThe ability of a med
- Page 217 and 218: A Reasonable NexusPrecise etiologic
- Page 219 and 220: integration of art and science are
- Page 221 and 222: Diamond M (2012) Scars and adhesion
- Page 223 and 224: General HistologyExtracellular Matr
- Page 225 and 226: Clinical ConsiderationVitamin C has
- Page 227 and 228: Ground substanceGround substance (G
- Page 229 and 230: Pathophysiological ConsiderationIn
- Page 231 and 232: HyaluronanThis hydrophilic, viscous
- Page 233 and 234: Clinical ConsiderationHA and its fr
- Page 236 and 237: Figure 2.1Layers and components of
- Page 238 and 239: Skin HistologyThe skin comprises:
- Page 241 and 242: Figure 2.2The delicate, well-hydrat
- Page 243 and 244: DermisThe dermis is made up of laye
- Page 245 and 246: Fascia Structure and FunctionsIn th
- Page 247 and 248: fundamental characteristic is its c
- Page 249 and 250: tensional properties co-exist in bo
- Page 251 and 252: HistologyFascia comprises:• ECM (
- Page 253 and 254: Clinical ConsiderationManual therap
- Page 255 and 256: Clinical ConsiderationTransforming
- Page 257 and 258: CollagenCollagen is the most abunda
- Page 259 and 260: Clinical ConsiderationSignificant c
- Page 261 and 262: Fascia Layers and FunctionsFascia t
- Page 263 and 264: Clinical ConsiderationSuperficial a
CHAPTER 1
Introduction
We are not just treating scars; we are treating people with scars
Pamela Fitch BA, RMT
In the developed world alone, a total of 100 million people develop scars each
year as a result of 55 million elective operations and 25 million operations after
trauma (Sund 2000). Current statistics estimate that over 50% of postsurgical
patients will experience scar-related complications (Diamond 2012).
Millions of people worldwide are afflicted with non-fatal burn injuries. Although
mortality and morbidity from burns have diminished significantly over the past
several decades, these statistics do not reflect the overall impact on the burn
survivor and how well they carry on with their life and manage post-burn
deformities, contractures and other disabilities that collectively present with
aesthetic and functional considerations (Goel & Shrivastava 2010).
The prevalence of occurrence, complications and sequelae associated with
problematic scars, of varying etiology, present important clinical, economic and
social considerations.
The occurrence of excessive scarring has been documented for centuries, dating
back to the Smith papyrus around 1700 BC (Berman & Bieley 1995). The
documented use of manual techniques in the treatment of wounds can be traced
back to the 1550s; Paré, a French surgeon, administered massage to relieve joint
stiffness and improve wound healing following surgery. It has also been
documented that during the World Wars, military nurses and, sometimes, doctors
provided massage as a component of scar treatment as a result of unplanned
events and planned trauma (surgery).
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