Physicians facing problematic burn and traumatic scars must develop a treatment plan. Such a plan is usually composed of a series of individual procedures. Among these procedures, some may be more invasive and others less so. Additionally, some interventions may require repeat application, while others may be performed just once. The order in which procedures are undertaken is also important and can influence the overall outcome.
In this volume, most individual chapters describe, in detail and with expert insights, specific procedures and steps in the management of burn and traumatic scars. Apart from knowing how to do what is necessary, it is also useful to consider the when, the appropriate timing of various procedures. Similarly, in keeping with this bigger-picture approach, it can also be useful to review the what, or which procedures may be most useful for which subtypes of scars (Fig. 6-1).
Treatment algorithm for re-epithelialized burn and traumatic scars.
The first step in scar treatment is scar assessment. For some burn and traumatic scars, the initial assessment may precede any scar treatment interventions by weeks or months, during which the acute wound is managed and gradually heals. For scars that affect the activities of daily life by posing functional impediments, such as range of motion restriction, initial scar assessment may entail more precisely measuring the nature and extent of the functional limitation. For scars that are disfiguring or embarrassing and may affect work or social interactions, initial assessment may include querying the patient to better understand which specific scars, or which characteristic of the scars, is most troublesome. Needless to say, these are not mutually exclusive approaches, as a scar could be healing slowly and eventually result in both functional restriction and disfigurement.
The process of initial scar assessment should also lead to the development of rapport and trust between the physician and the patient. Scars, and the events that caused them, can be emotionally fraught for patients, and scar treatment can require many visits, which require a commitment of time and money. Patients who perceive their physicians as empathetic may be more able to communicate important information about their scars and their expectations and to work collaboratively with their physicians to achieve an optimal result. When patients are very emotionally troubled about their scar, the physicians treating the scar may also consider, and discuss with the patients, the possible benefits of concurrent care by a therapist or psychiatrist.
For extensive burn wounds, in particular, postburn rehabilitation is crucial for minimizing scar formation. The formation of contractures may be reduced by the judicious use of splints and other appliances and other forms of rehabilitation. Pain is actively managed through a multidisciplinary approach so as to both provide acute relief ...