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[libribook.com] Traumatic Scar Tissue Management 1st Edition
myokinetic chain/myofascial meridian). Additionally, the fascia from the sternaand costal heads are continuous with the axillary fascia and the medial brachialfascia (Fourie 2008).In addition to musculature and fascia, five identifiable groups of lymph nodesare found in the axilla. These groups reside in the fatty CT of the axilla or arearranged around the blood vessels such as the lateral thoracic and subscapulararteries and the axillary vein. These nodes drain the lymphatic vessels of theipsilateral upper quadrant (both anterior and posterior), the ipsolateral mammarygland and the ipsilateral extremity (Zuther 2011). Seventy-five percent of thelymph from the breast and areolar plexus drains into the anterior pectoral groupof lymph nodes before they move to the central nodes.When any of the lymph nodes are removed, the flow and pathway of lymphaticfluid is disrupted and fibrosis may occur contributing to the development ofAWS.As scar formation is the body’s mechanism for restoring tissue integrity, allwounds are subject to the repair process. For internal tissue injuries andinflammation involving fascia, scarring and adhesions contribute to theoccurrence of tissue rigidity, abnormal movement patterns and pain.Issues after breast cancer surgery that result in AWS may arise from thematuring process of CT and the prolonged inflammatory phase of woundhealing. The CT maturation could result in either a dense, non-pliable scar or apliable mobile scar. A prolonged inflammatory phase results in hypertrophicscarring and increased fibrosis in the damaged area (Fourie 2008).
Clinical ConsiderationIt has been demonstrated – via ultrasound imaging – that skin rolling canmodify collagen density (Pohl 2010).Scar tissue can develop up to 6 months after treatment is complete. The skin maybecome hard, thick or feel bound in the areas that have been irradiated; surgicalsites can also be aggravated (MacDonald 2003).Scarring from radiation or surgery disturbs the lymphatic flow and, if notaddressed, can create an environment for fibrosis. Add to this the fact thatlymphatic pathways do not re-establish themselves across scars and you coulddraw the conclusion that un-drained lymphatic fluid contributes to thepathogenesis of the raised and swollen tissues abutting a scar (Warren & Slavin2007).Although no protocols exist, several excellent case studies indicate that acombination of manual lymph drainage techniques, myofascial release, snappingor popping of the cords and ROM exercises with passive stretching can bringabout productive outcomes (Bock, 2013).Breast Cancer-Related NeuropathyChemotherapy-associated peripheral neuropathy is the most common cause ofbreast cancer-related neuropathy. Chemotherapy medications travel throughoutthe body, where they can cause damage to the nerves (BreastCancer.org. 2015c).Certain chemotherapy medications can cause neuropathy. Chemotherapyassociatedneuropathy may begin as soon as treatment starts, and it may worsenas treatment continues. Usually it begins in the toes, but it can expand to includethe legs, arms, and hands. The most common symptoms include:• Pain, tingling, burning, weakness, tickling, or numbness in arms, hands, legs,and feet• Sudden, sharp, stabbing, or shocking pain sensations
- Page 491 and 492: Fitch P (2005) Scars of life. Journ
- Page 493 and 494: Langevin HM (2006) Connective tissu
- Page 495 and 496: active scars. Journal of Bodywork a
- Page 497 and 498: trauma.
- Page 499 and 500: Clinical ConsiderationPostsurgical
- Page 501 and 502: following burn injury,bacterial col
- Page 503 and 504: Table 6.1Comparison of scars (Ogawa
- Page 505 and 506: Pathophysiological ConsiderationAcc
- Page 507 and 508: BurnsA burn injury to the skin or o
- Page 510 and 511: Figure 6.1Depth of burn trauma and
- Page 512 and 513: • Stimulate ECM formation• Regu
- Page 514 and 515: Clinical ConsiderationIt has been i
- Page 516 and 517: Clinical ConsiderationMT may be a v
- Page 518 and 519: ThermoregulationThermoregulation (t
- Page 520 and 521: from the tissues and taken up by th
- Page 522 and 523: treatment strategies are difficult
- Page 524 and 525: Clinical ConsiderationSkin rolling
- Page 526 and 527: Sequelae and ComplicationsAdvances
- Page 528 and 529: • Paresthesia - 47%• Arm/should
- Page 530 and 531: breast or around the edge of the ar
- Page 532 and 533: Radiation scarringScar tissue as a
- Page 534 and 535: Implants and painPain of fluctuatin
- Page 536 and 537: LymphedemaBreast cancer treatment o
- Page 538 and 539: volume of fluid that accumulates or
- Page 540 and 541: OneTwoThreeCommonly referred to as
- Page 544: • Loss of touch sensation• Clum
- Page 548 and 549: Figure 6.3Distribution of nerves in
- Page 550 and 551: include preservation of as much of
- Page 552 and 553: complication is present there is de
- Page 554 and 555: Clinical ConsiderationScar complica
- Page 556 and 557: BreastCancer.org (2015c) Side Effec
- Page 558 and 559: 323-9.Kania A (2012) Scars. In: Dry
- Page 560 and 561: Slemp AE, Kirschner RE (2006) Keloi
- Page 562 and 563: scar tissue, while being mindful of
- Page 564 and 565: Physiological ResponseAs discussed
- Page 566 and 567: • The realization that one is abo
- Page 568 and 569: Stress Response and Stress Hormones
- Page 570 and 571: dissociation and inner shakiness) (
- Page 572: Figure 7.1(A) Summary of the HPA me
- Page 575 and 576: Chronic Stress ResponseChronic stre
- Page 577 and 578: Pathophysiological ConsiderationChr
- Page 579 and 580: Clinical ConsiderationProlonged str
- Page 581 and 582: Psychological Stress and Wound Heal
- Page 583 and 584: Pathophysiological ConsiderationNor
- Page 585 and 586: Pathophysiological ConsiderationStr
- Page 587 and 588: Clinical ConsiderationAccording to
- Page 589 and 590: Clinical ConsiderationEvidence sugg
- Page 591 and 592: Clinical ConsiderationAccording to
myokinetic chain/myofascial meridian). Additionally, the fascia from the sterna
and costal heads are continuous with the axillary fascia and the medial brachial
fascia (Fourie 2008).
In addition to musculature and fascia, five identifiable groups of lymph nodes
are found in the axilla. These groups reside in the fatty CT of the axilla or are
arranged around the blood vessels such as the lateral thoracic and subscapular
arteries and the axillary vein. These nodes drain the lymphatic vessels of the
ipsilateral upper quadrant (both anterior and posterior), the ipsolateral mammary
gland and the ipsilateral extremity (Zuther 2011). Seventy-five percent of the
lymph from the breast and areolar plexus drains into the anterior pectoral group
of lymph nodes before they move to the central nodes.
When any of the lymph nodes are removed, the flow and pathway of lymphatic
fluid is disrupted and fibrosis may occur contributing to the development of
AWS.
As scar formation is the body’s mechanism for restoring tissue integrity, all
wounds are subject to the repair process. For internal tissue injuries and
inflammation involving fascia, scarring and adhesions contribute to the
occurrence of tissue rigidity, abnormal movement patterns and pain.
Issues after breast cancer surgery that result in AWS may arise from the
maturing process of CT and the prolonged inflammatory phase of wound
healing. The CT maturation could result in either a dense, non-pliable scar or a
pliable mobile scar. A prolonged inflammatory phase results in hypertrophic
scarring and increased fibrosis in the damaged area (Fourie 2008).
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