Abstract
The rehabilitation of burns and scars depends on the maturation of the scar tissue. During the inflammation stage, all the risks of scar contracture and functional scar sequelae happen. The therapists must anticipate and prevent the possible consequences of an immature tissue. Besides the postures and the correct positioning with specific splints, manual massages are part of scar treatment. They have to be applied by specialized therapists around the scar at first and progressively on the scar or burn scar while respecting the fragility and inflammation of the tissue. The most important being in the choice of the technique is to respect the cutaneous inflammation.
You have full access to this open access chapter, Download chapter PDF
Similar content being viewed by others
Keywords
1 Background
Scar massages are used to improve skin qualities in terms of flexibility, adhesions, pruritus, and pain. The specific techniques are not always mastered by all the therapists. Indeed pathological scars can appear following strong massage movements or too long sessions during the inflammation stage . The techniques must be controlled and take into account the inflammation, the appearance, and the localization of the scar.
2 Introduction
Care of the burn skin and scars requires specific treatments to reduce and control the inflammation stage and its consequences [1, 2]. Adapted rehabilitation technique restores flexibility and limits esthetic and functional sequelae. The treatment will progress and be adapted throughout the scar maturation process. Several specific manual massages are part of the treatment but have to be applied respecting the inflammation, the fragility, and the localization of the scar [3, 4, 5].
3 Indications of Manual Massages
Manual massages allow to improve cutaneous mobility compared with the deep plan and its elasticity. They are indicated on burn scars but also in case of traumatic or surgical scars [6].
They can be started as soon as the scar tissue is epidermized and solid and allows to support specific manual techniques. The massages are contraindicated when the tissue is thin and hyper-inflammatory. When the skin is fragile and presents a vitropression test less than 1.2 seconds, the massages will be realized at first around the scar [7, 8].
4 Description of the Techniques
4.1 Morice Orthodermic Stretching
Orthodermic stretchings such as they were described by René Morice are compatible with an inflammatory skin. Indeed the technique can be summarized by a fixed pulpaire pressure associated with a moderated stretching supported in the inverse direction of the retraction. This kind of massages is frequently used on the face and dorsal side of the hand.
4.2 Punctual Crushing
The punctual crushing is also used during the inflammatory stage and allows to crush the edges of grafts or hypertrophic scars. The pressure is moderated, vertical, and realized with the pulp of one or several fingers. The pressure can be circular but without practicing however of friction or lifting fingers.
4.3 Static Fold
Statics folds are realized during the inflammation stage on a solid epidermis and when the vitropression test is close to 2 seconds. They improve various plans if sliding and have an action on the suppleness of the skin. According to the surface or area to be treated, they are realized between two fingers or more globally between two hands. There are no movements of friction during this care.
4.4 Palpate-Rolling
When the vitropression test gets closer to 3 seconds, the static fold evolves in rolled fold. This also significantly softens the deep plans and fibrosis scars. Palpate-rolling has also an interest to raise adhesions. It is crucial to observe the scar tissue before, during, and after the massage treatment.
4.5 Efficacy
The massages are widely used within the care and rehabilitation of burns and scars.
The techniques have a role in the improvement of the characteristics and evolution of the scar.
5 Conclusion
Treatment of skin and scar following burn injuries must be performed with caution and requires the input of the whole multidisciplinary team. It is necessary to align the treatment according to the stage of scar maturation. The inflammation of the scar is the main factor to consider to guide the therapist’s treatment [9].
Change history
18 March 2021
Owing to an oversight on the part of the production, this chapter was initially published with incorrect authorship. The chapter was published with first author name alone, co-authors were inadvertently missed.
Bibliography
Anthonissen M, Daly D, Janssens T, Van den Kerckhove E. The effects of conservative treatments on burn scars: a systematic review. Burns. 2016;42(3):508–18. https://doi.org/10.1016/j.burns.2015.12.006. Epub 2016 Jan 15.
Gavroy JP, Poveda A, Oversteyns B, Plantier G, Rouget D, Griffe O, Teot L, Costagliola M, Ster F. Intérêt du "test de vitro pression" dans le suivi des cicatrices de brulures a partir de 50 observations. Ann Medit Burns Club. 1995;VIII(1).
Cho YS, Jeon JH, Hong A, Yang HT, Yim H, Cho YS, Kim DH, Hur J, Kim JH, Chun W, Lee BC, Seo CH. The effect of burn rehabilitation massage therapy on hypertrophic scar after burn: a randomized controlled trial. Burns. 2014;40(8):1513–20. https://doi.org/10.1016/j.burns.2014.02.005. Epub 2014 Mar 12.
Shin TM, Bordeaux JS. The role of massage in scar management: a literature review. Dermatol Surg. 2012;38(3):414–23. https://doi.org/10.1111/j.1524-4725.2011.02201.x. Epub 2011 Nov 7.
Roques C, Téot L, Frasson N, Meaume S. PRIMOS: an optical system that produces three-dimensional measurements of skin surfaces. J Wound Care. 2003;12(9):362–4. PMID: 14601231.
Ault P, Plaza A, Paratz J. Scar massage for hypertrophic burns scarring-a systematic review. Burns. 2018;44(1):24–38. https://doi.org/10.1016/j.burns.2017.05.006. Epub 2017 Jun 29.
Najafi Ghezeljeh T, Mohades Ardebili F, Rafii F, Manafi F. The effect of massage on anticipatory anxiety and procedural pain in patients with burn injury. World J Plast Surg. 2017;6(1):40–7.
Najafi Ghezeljeh T, Mohades Ardebili F, Rafii F. The effects of massage and music on pain, anxiety and relaxation in burn patients: randomized controlled clinical trial. Burns. 2017;43(5):1034–43. https://doi.org/10.1016/j.burns.2017.01.011. Epub 2017 Feb 4.
Finnerty CC, Jeschke MG, Branski LK, Barret JP, Dziewulski P, Herndon DN. Hypertrophic scarring: the greatest unmet challenge following burn injury. Lancet. 2016;388(10052):1427–36.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Open Access This chapter is licensed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.
The images or other third party material in this chapter are included in the chapter's Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the chapter's Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.
Copyright information
© 2020 The Author(s)
About this chapter
Cite this chapter
Frasson, D.N., Valange, M., Almeras, I., Izquierdo, M., Ster, G. (2020). Treatment of Immature Scars: Manual Massages. In: Téot, L., Mustoe, T.A., Middelkoop, E., Gauglitz, G.G. (eds) Textbook on Scar Management. Springer, Cham. https://doi.org/10.1007/978-3-030-44766-3_25
Download citation
DOI: https://doi.org/10.1007/978-3-030-44766-3_25
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-44765-6
Online ISBN: 978-3-030-44766-3
eBook Packages: MedicineMedicine (R0)