Burns and Scar Management in Occupational Therapy

It is an Occupational Therapists’ role to provide high quality, person-centred Burns and Scar Management Therapy to people of all ages experiencing excessive scarring. Therapist aims to decrease the cosmetic appearance and facilitate engagement in functional activities and movement (Edgar & Brereton, 2004): and is achieved through education and non-invasive intervention techniques including: scar massage, pressure garments, silicone gel sheeting, splinting and stretch (Monstrey et al, 2014). Scar management began from Ancient Egyptians belief that raw honey could treat wounds, infections and prevent scarring (Richard & Staley, 1994).

As an Occupational Therapist, I have a strong passion to work with client’s experiencing excessive scarring to facilitate functional engagement in meaningful and purposeful occupations, with a vision for challenging social stigmatisation to enhance social interaction and acceptance within client’s communities. 

Scarring is a formation of newly synthesized dermal collagen (produced by fibroblasts) in response to trauma, burns, operations or infections. Scar tissue forms in a disorganised fashion, with collagen forming in closely packed whirl like patterns causing excessive “lumpy bumpy” scarring (Hawkins & Pereira, 2007). It is estimated that each year approximately 100 million people in the developing world acquire scars, of these 15% have excessive scarring influencing function and aesthetics (Monstrey et al, 2014). Excessive scarring causes physical and psychological symptoms (Monstrey et al, 2014). Scarring is classified as hypertrophic or keloid scars, the difference between the two is outlined below: 

Hypertrophic Scarring	Keloid Scarring
·   Grows within the boundaries of the original wound. ·   Presentation: Red, Raised and Ridged ·   Scar height can range from 0 - 5mm ·   Maturation time: 6-24 months when the scar is observed as pale, planer and pliable (Hunasgi, Koneru, Vanishree, & Shamala, 2013).	·   Grows over the boundaries of the original wound in a mushroom shape. ·   Presentation: Firm, Hard, Raised and slightly pink to dark in colour. ·   Scar height ranges from 0-5mm to several cm ·   Maturation time: 1-2 years or they can be active for life and constantly changing (Hunasgi, Koneru, Vanishree, & Shamala, 2013).
Figure 1 - Hypotrophic scar Hypertrophic scar (n.d) hypertrophic scar [Image] Retrieved from: https://www.dermnetnz.org/topics/keloids-and-hypertrophic-scars/	Figure 2 - Keloid Scar  Keloid scar (n.d) keloid scar [Image] Retrieved from: https://www.dermnetnz.org/topics/keloids-and-hypertrophic-scars/

References:

Edgar, D., & Brereton, M. (2004). ABC of burns: Rehabilitation after burn injury. BMJ: British Medical Journal, 329(7461), 343. doi: 10.1136/bmj.329.7461.343

Hawkins, H. & Pereira, C. (2007). Pathophysiology of burn scar. In Herndon, D. N. (Ed.). Total Burn Care (3^rd Ed., pp. 612-613). Texas, US: Sauders Elsevier.

Hunasgi, S., Koneru, A., Vanishree, M., & Shamala, R. (2013). Keloid: A case report and review of pathophysiology and differences between keloid and hypertrophic scars. Journal of Oral and Maxillofacial Pathology: JOMFP, 17(1), 116. doi: 10.4103/0973-029x.110701 

Monstrey, S., Middelkoop, E., Vranckx, J. J., Bassetto, F., Ziegler, U. E., Meaume, S., & Téot, L. (2014). Updated scar management practical guidelines: Non-invasive and invasive measures. Journal of Plastic, Reconstructive & Aesthetic Surgery, 67(8), 1017-1025. doi: 10.1016/j.bjps.2014.04.011 

Richard, R., & Staley, M. (1994). Burn care and rehabilitation principles and practice. Philadelphia, PA: F.A Davis.