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

Table 9.4
Treatment guideline summary
Depending on the location of the edema, the thorax, ipsilateral and contralateral
axillary, abdominal area, or inquinal lymph nodes may need to be activated.
If the lymphatic system is compromised in any way, techniques to engage the
deeper nodes and the superficial nodes proximal to the scarred area are essential
in removing the fluid. The lymph fluid is re-routed via tissue channels,
anastomoses or collateral lymph vessels into more centrally located lymph
vessels and nodes (Zuther 2011).
During Wound Healing
The goal of treatment during wound healing is to attenuate undue edema and to
support tissue healing.
During the early stages of healing (day 2–6), edema is usually liquid, soft and
easy to mobilize or move. Gentle lymphatic techniques (no more than PL3)
applied proximal to the injury site can assist with lymph transport.
Scars, Adhesions and Edema
Scars and adhesions disrupt the network of lymph capillaries and hinder lymph
drainage. This makes the treatment of edema in the affected area more difficult.
When performing lymphatic techniques, scars can interrupt the lymph flow.
When there is a scar in the stroke pathway, it is recommended that you stroke
around the scar and not through it because the transfer of fluid across a scar is
usually ineffective.
Scars located perpendicular to lymph collectors can prevent lymphatic drainage,
especially if the scar tissue adheres to the fascia or exceeds 3 mm in width
(Zuther 2011).