Author: Zhang, Walei
Title: Post burn hypertrophic scar pliability, its assessment and treatment
Advisors: Li, Cecilia (RS)
Degree: Ph.D.
Year: 2019
Subject: Hong Kong Polytechnic University -- Dissertations
Hypertrophic scars
Burns and scalds
Department: Department of Rehabilitation Sciences
Pages: xxi, 183 pages : color illustrations
Language: English
Abstract: Background: Hypertrophic scar (HS) resulting from burn injuries can cause deformities that severely affect the survivor’s functioning and psychological well-being, leading to a significant reduction in quality of life. Pliability is one of the most important HS parameters because it reflects the skin’s flexibility, and a reduction in pliability may hinder movement and thus mobility. Valid objective assessment of pliability is crucial to monitor patients’ improvement, but the most appropriate assessment method and the most effective treatment for the improvement of HS pliability have yet to be established. A combination of pressure therapy and silicone-based therapy has been recommended as the first-line noninvasive treatment, but its ability to improve HS pliability remains unclear. Aims and Objectives: The aim of this study was to determine the proper assessment of HS pliability and to investigate the effects of a combination of pressure and silicone therapy on improving the pliability of HS. The objectives of the study were as follows. 1) to investigate the most appropriate method to assess the pliability of HS via critical appraisal of the current evidence; 2) to establish the validity of the elasticity measurement of the DermaLab Combo in the measurement of HS pliability; 3) to investigate the properties of a newly invented Smart Scar-Care pad (SSCP) as a suitable insert material for combined pressure and silicone therapy; and 4) to investigate the clinical efficacy of the SSCP in improving HS pliability with the use of objective HS assessment tools. Methods: A systematic review was conducted to evaluate the current evidence regarding the assessment of HS pliability from a biomechanical perspective. A validation study was then performed to establish the concurrent validity and clinical relevance of the upgraded elasticity measurement of the DermaLab Combo in measuring HS pliability with a modified tissue tonometer (MTT) and the modified Vancouver Scar Scale (mVSS). As for treatment, the properties of the newly invented SSCP were investigated and compared with commercially available products in tests of biological safety, physical properties, and the ability to increase the interface pressure between the HS tissue and the pressure garment. Finally, a comprehensive treatment strategy to improve HS pliability via enhanced compression and occlusion was implemented with the SSCP. The clinical efficacy was investigated via a self-controlled clinical trial, the clinical outcomes were measured with a series of objective scar assessment tools, and patient feedback was collected.
Results: The systematic review showed that the suction method with greater suction power administered by an adhering probe on the assessment area was most appropriate for the assessment of HS pliability. Of all the equipment using the suction method, the upgraded version of the DermaLab Combo elasticity measurement used the highest pressure, which made it possible to assess the pliability of thick and stiff HS. A significant correlation was identified between HS pliability as measured by the DermaLab elasticity measurement and the hardness score as measured with the MTT. A significant correlation was also established between the DermaLab elasticity measurement and the pliability score of the mVSS. The SSCP demonstrated superior performance over commercially available products in tests of biological safety and physical properties, and it significantly increased the interface pressure between the scar tissue and the pressure garment. In the self-controlled clinical trial, 32 subjects were recruited and 25 completed the treatment. Significant time effects were found for the Vancouver Scar Scale total score, the melanin score, pliability, and the hydration score. A significant intervention and time interaction effect was found for pliability (p=.048). No significant time or interaction effect was found for thickness. On the feedback questionnaire, the patients reported that the SSCP was significantly more conformable (p=.02) and displayed less displacement during movement than the conventional pressure insert (p=.040). Conclusions: The measurement principles and administration procedures of the methods have a great effect on the clinimetrics of HS pliability measurement. The upgraded elasticity measurement of the DermaLab Combo is the most appropriate HS pliability assessment tool commercially available. The SSCP can serve as a safe and effective insert material for enhancement of the pressure interface and occlusion. Comprehensive treatment strategies implemented with the SSCP have demonstrated greater effectiveness in improving the pliability of HS and possibly in preventing its thickening; it was found to be more comfortable and less likely to become displaced during movement than the conventional pressure insert.
Rights: All rights reserved
Access: open access

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