Scar Management: Compression garments
Pressure therapy for scar management, also known as compression therapy, is an important component of a burn patient’s rehabilitation program. Elastic bandages or compression garments are used to provide pressure over healing burns and grafts when they are durable enough to tolerate the shearing that occurs from the fabric against the skin. This compression minimizes the development of scars by interfering with the production of collagen and helping to realign the collagen fibers. Benefits associated with compression include its ability to:
- Protect fragile skin
- Promote better circulation of damaged tissues
- Decrease extremity pain through vascular support
- Decrease itching
- Reduce thick, hard scars
- Increase skin length by putting pressure on contracture bands
Types of compression garments
- Elastic wrap bandages (Ace Wrap): Used initially to provide pressure on arms and legs.
- Tubular pressure bandages (Tubigrip): Used initially to provide gentle pressure.
- Interim care garments: off the shelf garments used for pressure until custom-made garments are available.
- Custom-made garments: nylon spandex garments made to patient’s measurements by one of the manufacturers that specialize in burn compression garments.
Compression garments should be worn 7 days a week, 23 hours per day. They can be removed for bathing and when applying lotion. These garments will need to be worn until the scars are mature – soft, flat, pliable and when the color is close to your skin tone. It takes between 8 months up to 1-2 years before scars are mature. This depends on the depth of burn, genetic and other factors.
Care of compression garments
Hand wash compression garments using mild soap or detergent. Do not use bleach as this can damage the material. If a washer is used, it is best to use a gentle or hand wash cycle. Hang or lay flat to dry; do not use a dryer.
Rub moisturizing lotion or cream completely into the skin before putting on the garment.
Replace garments when they become loose and worn. Typically three sets of garments last about three months.
Scar management: inserts and silicone gel sheets
If a scar is located in a concave area of the body or if the compression garment itself is not effectively compressing the scar, additional inserts or silicone gel sheets may be added.
Inserts can be made of felt, foam, elastomer (a silicone rubber compound) or other materials. These inserts are worn under compression garments to place additional compression on unyielding burn scars.
Silicone products come in a variety of forms: in flexible sheets, creams or liquids or on a band aid. The gel sheets are reusable and should be washed each day. They can be worn alone or under a compression garment.
Scar Management: Scar massage
Massaging the burn scar is another technique used to assist in softening the scar and releasing any adhesions which may be present in the scar bands. Massaging can begin when the burn or skin graft is durable enough to tolerate pressure and friction without blistering. Initially, the massage is done with light pressure, moving the skin in a rotating motion without friction. As the skin becomes more durable, pressure can increase and frictional massage can be initiated.
Here are some instructional videos which can assist patients and families in learning the scar massage techniques.
Just for fun
The first medical reference to the use of pressure for burn treatment occurred in 1678, referring to the work of Ambroise Pare in the sixteenth century. The first known uses of pressure for burn treatment in children occurred in:
- 1860 (elastic bandages)
- 1881 (adhesive plaster for pressure)
- 1902 (traction to treat scars)
- Jobst was the first company to commercially manufacture compression garments.