[libribook.com] Traumatic Scar Tissue Management 1st Edition

Treatment outcomes
The later stages of healing primarily focus on improving tissue hydration and the
state of GS, reducing or preventing undue adhesions and pathophysiological scar
formation, and guiding the healing tissue in its ability to attain, as close as
possible, normal collagen architecture and functional capabilities.
During the remodeling stage, MT may shorten the time needed to form a healthy,
mature scar (Cho et al. 2014). As noted, timing is everything, so early
intervention (no later than 2 weeks post-trauma) may be ideal for the purpose of
preventing or reducing the risk of delayed healing and subsequent
pathophysiological scar formation. Additionally, treatment in this time frame
may prove beneficial in reducing pain and pruritus.
Myofibroblast (MFB) activity is an important part of wound healing, as the
tension generated by MFBs facilitates wound gap closure and formation of a
mechanically sound scar. However, excess MFB-driven tension can result in
excess collagen deposition, and so attenuating undue tissue tension is an
important scar management component.
Bove and Chapelle (2012) assert that keeping things moving during healing may
reduce or prevent layers from getting adhered to one another. If left unchecked
or immobile, collagen fibers will cross-link and adhere in ways that can restrict
movement, visceral motility and negatively impact muscle force generating
capacity. Movement/mobilization ensures that newly formed tissue fibers align
in a manner that allows for unrestricted motion. Movement/mobilization also
impacts GS in ways that ensure tissue slide capabilities and fiber stability
(Hertling & Kessler 2006, Meert 2012, Stecco et al. 2013).