Summary of the Evidence that Support of Refute the Use of Common Conservative Treatment Interventions for Scar Management Following Burn Injury
| Treatment intervention . | Proposed mechanism supporting (√) or refuting (X) this intervention . | Clinical considerations . | |
|---|---|---|---|
| Edema management | Compression | (√) Mechanical off-loading59-62 (√) Reduces inflammatory response, neurogenic inflammation79–83 | • Compression for edema reduction should be initiated 48–72 hours postinjury.77 |
| Positioning/Elevation | (√) Gravity assists the drainage of edema, which could help reduce the inflammatory response, neurogenic inflammation84,85 | • Elevation should be used in combination with other edema management techniques.85,88 | |
| Pumping Exercises | (√) Muscle contractions assist the drainage of edema, which could help reduce the inflammatory response and neurogenic inflammation85,89,90 | • Active pumping exercises or electrical stimulation should be used in combination with other edema management techniques.89,90 | |
| Retrograde massage/Manual edema mobilization (MEM) | (√) Manually assists the drainage of edema, which could help reduce the inflammatory response, neurogenic inflammation87 | • Retrograde massage/MEM should be used in combination with other edema management techniques.87 | |
| Pressure therapy (Including: pressure garments, inserts, face masks, and low-load long duration orthoses) | (√) Mechanical off-loading21,47,57–61,70,79,98–110,122–126 (√) Reduces neurogenic inflammation10,68–74 | • Custom-fabricated garments should be applied once edema is stabilized and there is adequate healing. • Optimal pressure is >15 mm Hg.21,47,108 • Use inserts when necessary.47 • Wearing time should be >16 hours/day.98,109,110 | |
| Gels or Gel Sheets | (√) Mechanical off-loading20,59–62,128–131 (√) Reduces Neurogenic inflammation10,68–74 (√) Occlusion19,20,72 (√) Hydration19,20,72 (√) Temperature increase19,20,72,128–131 | • Gels should extend beyond the scar edge.128 | |
| Serial casting | (√) Mechanotransduction21,30,32,143,145,146,148–151 | • Serial casting should be applied when contractures interfere with function.30,32,143 | |
| Scar massage | (X) Mechanotransduction46,51–57,152,154–158 (X) Neurogenic inflammation10,70–74,152,154–158 | • Scar massage, other than light effleurage for moisturizer application, should be avoided early in the wound healing process or when scars are inflamed or break down.26,152 | |
| Passive stretching | (X) Mechanotransduction10,46,51–57,63–74,168–171 | • Other treatment modalities such as AROM, strengthening exercises, or low-load long duration orthoses should be prioritized over passive stretching for scar management.145,169–172 | |
| Treatment intervention . | Proposed mechanism supporting (√) or refuting (X) this intervention . | Clinical considerations . | |
|---|---|---|---|
| Edema management | Compression | (√) Mechanical off-loading59-62 (√) Reduces inflammatory response, neurogenic inflammation79–83 | • Compression for edema reduction should be initiated 48–72 hours postinjury.77 |
| Positioning/Elevation | (√) Gravity assists the drainage of edema, which could help reduce the inflammatory response, neurogenic inflammation84,85 | • Elevation should be used in combination with other edema management techniques.85,88 | |
| Pumping Exercises | (√) Muscle contractions assist the drainage of edema, which could help reduce the inflammatory response and neurogenic inflammation85,89,90 | • Active pumping exercises or electrical stimulation should be used in combination with other edema management techniques.89,90 | |
| Retrograde massage/Manual edema mobilization (MEM) | (√) Manually assists the drainage of edema, which could help reduce the inflammatory response, neurogenic inflammation87 | • Retrograde massage/MEM should be used in combination with other edema management techniques.87 | |
| Pressure therapy (Including: pressure garments, inserts, face masks, and low-load long duration orthoses) | (√) Mechanical off-loading21,47,57–61,70,79,98–110,122–126 (√) Reduces neurogenic inflammation10,68–74 | • Custom-fabricated garments should be applied once edema is stabilized and there is adequate healing. • Optimal pressure is >15 mm Hg.21,47,108 • Use inserts when necessary.47 • Wearing time should be >16 hours/day.98,109,110 | |
| Gels or Gel Sheets | (√) Mechanical off-loading20,59–62,128–131 (√) Reduces Neurogenic inflammation10,68–74 (√) Occlusion19,20,72 (√) Hydration19,20,72 (√) Temperature increase19,20,72,128–131 | • Gels should extend beyond the scar edge.128 | |
| Serial casting | (√) Mechanotransduction21,30,32,143,145,146,148–151 | • Serial casting should be applied when contractures interfere with function.30,32,143 | |
| Scar massage | (X) Mechanotransduction46,51–57,152,154–158 (X) Neurogenic inflammation10,70–74,152,154–158 | • Scar massage, other than light effleurage for moisturizer application, should be avoided early in the wound healing process or when scars are inflamed or break down.26,152 | |
| Passive stretching | (X) Mechanotransduction10,46,51–57,63–74,168–171 | • Other treatment modalities such as AROM, strengthening exercises, or low-load long duration orthoses should be prioritized over passive stretching for scar management.145,169–172 | |
Summary of the Evidence that Support of Refute the Use of Common Conservative Treatment Interventions for Scar Management Following Burn Injury
| Treatment intervention . | Proposed mechanism supporting (√) or refuting (X) this intervention . | Clinical considerations . | |
|---|---|---|---|
| Edema management | Compression | (√) Mechanical off-loading59-62 (√) Reduces inflammatory response, neurogenic inflammation79–83 | • Compression for edema reduction should be initiated 48–72 hours postinjury.77 |
| Positioning/Elevation | (√) Gravity assists the drainage of edema, which could help reduce the inflammatory response, neurogenic inflammation84,85 | • Elevation should be used in combination with other edema management techniques.85,88 | |
| Pumping Exercises | (√) Muscle contractions assist the drainage of edema, which could help reduce the inflammatory response and neurogenic inflammation85,89,90 | • Active pumping exercises or electrical stimulation should be used in combination with other edema management techniques.89,90 | |
| Retrograde massage/Manual edema mobilization (MEM) | (√) Manually assists the drainage of edema, which could help reduce the inflammatory response, neurogenic inflammation87 | • Retrograde massage/MEM should be used in combination with other edema management techniques.87 | |
| Pressure therapy (Including: pressure garments, inserts, face masks, and low-load long duration orthoses) | (√) Mechanical off-loading21,47,57–61,70,79,98–110,122–126 (√) Reduces neurogenic inflammation10,68–74 | • Custom-fabricated garments should be applied once edema is stabilized and there is adequate healing. • Optimal pressure is >15 mm Hg.21,47,108 • Use inserts when necessary.47 • Wearing time should be >16 hours/day.98,109,110 | |
| Gels or Gel Sheets | (√) Mechanical off-loading20,59–62,128–131 (√) Reduces Neurogenic inflammation10,68–74 (√) Occlusion19,20,72 (√) Hydration19,20,72 (√) Temperature increase19,20,72,128–131 | • Gels should extend beyond the scar edge.128 | |
| Serial casting | (√) Mechanotransduction21,30,32,143,145,146,148–151 | • Serial casting should be applied when contractures interfere with function.30,32,143 | |
| Scar massage | (X) Mechanotransduction46,51–57,152,154–158 (X) Neurogenic inflammation10,70–74,152,154–158 | • Scar massage, other than light effleurage for moisturizer application, should be avoided early in the wound healing process or when scars are inflamed or break down.26,152 | |
| Passive stretching | (X) Mechanotransduction10,46,51–57,63–74,168–171 | • Other treatment modalities such as AROM, strengthening exercises, or low-load long duration orthoses should be prioritized over passive stretching for scar management.145,169–172 | |
| Treatment intervention . | Proposed mechanism supporting (√) or refuting (X) this intervention . | Clinical considerations . | |
|---|---|---|---|
| Edema management | Compression | (√) Mechanical off-loading59-62 (√) Reduces inflammatory response, neurogenic inflammation79–83 | • Compression for edema reduction should be initiated 48–72 hours postinjury.77 |
| Positioning/Elevation | (√) Gravity assists the drainage of edema, which could help reduce the inflammatory response, neurogenic inflammation84,85 | • Elevation should be used in combination with other edema management techniques.85,88 | |
| Pumping Exercises | (√) Muscle contractions assist the drainage of edema, which could help reduce the inflammatory response and neurogenic inflammation85,89,90 | • Active pumping exercises or electrical stimulation should be used in combination with other edema management techniques.89,90 | |
| Retrograde massage/Manual edema mobilization (MEM) | (√) Manually assists the drainage of edema, which could help reduce the inflammatory response, neurogenic inflammation87 | • Retrograde massage/MEM should be used in combination with other edema management techniques.87 | |
| Pressure therapy (Including: pressure garments, inserts, face masks, and low-load long duration orthoses) | (√) Mechanical off-loading21,47,57–61,70,79,98–110,122–126 (√) Reduces neurogenic inflammation10,68–74 | • Custom-fabricated garments should be applied once edema is stabilized and there is adequate healing. • Optimal pressure is >15 mm Hg.21,47,108 • Use inserts when necessary.47 • Wearing time should be >16 hours/day.98,109,110 | |
| Gels or Gel Sheets | (√) Mechanical off-loading20,59–62,128–131 (√) Reduces Neurogenic inflammation10,68–74 (√) Occlusion19,20,72 (√) Hydration19,20,72 (√) Temperature increase19,20,72,128–131 | • Gels should extend beyond the scar edge.128 | |
| Serial casting | (√) Mechanotransduction21,30,32,143,145,146,148–151 | • Serial casting should be applied when contractures interfere with function.30,32,143 | |
| Scar massage | (X) Mechanotransduction46,51–57,152,154–158 (X) Neurogenic inflammation10,70–74,152,154–158 | • Scar massage, other than light effleurage for moisturizer application, should be avoided early in the wound healing process or when scars are inflamed or break down.26,152 | |
| Passive stretching | (X) Mechanotransduction10,46,51–57,63–74,168–171 | • Other treatment modalities such as AROM, strengthening exercises, or low-load long duration orthoses should be prioritized over passive stretching for scar management.145,169–172 | |
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