As continued support for Cancer Rehab Awareness Week 2021. We want to talk about and elaborate on a topic we work closely with;

"Scar Management". 

We recently presented to the nurses at the Breast Care Foundation and now  can be found on their directory for anyone that may have issues with their scar post-operatively from Breast surgery or any other surgery. 

Scar development and pain/sensitivity 

Hypertrophic and keloid scar formation can occur as a result of surgical interventions, trauma burns or spontaneously. These wound healing disorders lead to functional issues as-well as cosmetic and sensory disorders. Pathophysiologically, what occurs is a disbalance between synthesis and degradation of the extracellular matrix causing an over development of cell and tissue production (2). 

Hypertrophic scarring can vary but has an incident rate of 40% to 70% following surgery (3).

Gärtner 2009 study indicated around 50% of patients that under go breast surgery as part of their treatment for breast cancer described persistent breast pain and inferior quality of life after, therefore pain and scarring after breast surgery is of high relevance in the rehabilitation process (1). 

Dieterich's 2020 study demonstrated a prevalence of scar pain of 30.8% after Breast Conserving Therapy and 34.5% after mastectomy. 37.8% of these patients demonstrated  persistent pain. In both groups, scar pain was associated with increased restrictions in the arm movement as well as impairing quality of life.

A major factor in the study was a lack of postoperative information about scar care measures given to the patients. 

Since individuals often experience a diversity of scar characteristics and symptoms, which then play a central role in the perceived impact on HRQOL. Potential scarring after prophylactic, oncologic and reconstructive breast surgery should be given more attention in clinical practice (4). 

Silicone as a treatment 

Clinical effects of silicone therapy Silicone sheets have proven to result in reduction of thickness, erythema, pain, itchiness, and pliability of hypertrophic scars (6)

Silicone products should ideally be worn for between 12 and 24 hours a day. In general, total therapy duration — for both hypertrophic and keloid scars — should be at least 2 to 3 months, while a treatment period of 6 months can prevent recurrence.(7)

Scarban dressings are the most frequently recommended dressings because:

-The dressing stays in place, also in skin folds

-It feels soft and comfortable thanks to the unique, stretchable fabric used for the outer layer

-It consists of 100% silicone and offers very high UV protection(SPF50)

 -Is a medical, silicone therapy that ensures quicker and improved healing of the skin. 

- Ensures that existing scars become flatter, smoother and thinner. The scar is less disfiguring, and in many cases becomes almost invisible.

-Our scar gel provides a sun protection factor of 25 (SPF 25) to protect scars against damaging UV radiation.

 References

1) Gärtner R, Jensen MB, Nielsen J, Ewertz M, Kroman N, Kehlet H. Prevalence of and factors associated with persistent pain following breast cancer surgery. JAMA. 2009 Nov 11;302(18):1985-92. doi: 10.1001/jama.2009.1568. Erratum in: JAMA. 2012 Nov 21;308(19):1973. PMID: 19903919.

2) Dieterich M, Allmendinger S, Gerber B, Reimer T, Hartmann S, Stachs A, Stubert J: Prevalence, Clinical Significance and Risk Factors for Developing Scar Pain and Sensibility Disorders in Breast Cancer Patients after Breast-Conserving Therapy and Mastectomy. Breast Care 2020. doi: 10.1159/000513241

3) Gauglitz, G. G., Korting, H. C., Pavicic, T., Ruzicka, T., & Jeschke, M. G. (2011). Hypertrophic scarring and keloids: pathomechanisms and current and emerging treatment strategies. Molecular medicine (Cambridge, Mass.), 17(1-2), 113–125. https://doi.org/10.2119/molmed.2009.00153

4) Everaars, K.E., Welbie, M., Hummelink, S. et al. The impact of scars on health-related quality of life after breast surgery: a qualitative exploration. J Cancer Surviv 15, 224–233 (2021). https://doi.org/10.1007/s11764-020-00926-3

5) Chang CS, Wallace CG, Hsiao YC et al. (2018). Clinical evaluation of silicone gel in the treatment of cleft lip scars. Sci Rep 8: 7422

6)  Wang F, Li X, Wang X, Jiang X. Efficacy of topical silicone gel in scar management: A systematic review and meta-analysis of randomised controlled trials. Int Wound J. 2020 Jun;17(3):765-773. doi: 10.1111/iwj.13337. Epub 2020 Mar 2. PMID: 32119763; PMCID: PMC7949016.

7) Durante, C. M., & Kant, S. Silicone therapy for the treatment and prevention of problematic scars: a practical guideline.