All You Need To Know About Scar Management

Scar formation is a general & inescapable outcome of tissue repairing in the last phase of the wound healing process ie. the maturation or remodeling phase where the fibrous tissue replaces normal tissue. This phase can last from 21 days to two years, especially in full-thickness wounds. However, the quantity of scar tissue generated can vary from patient to patient depending on the cause or nature of the injury. 

Wound care professionals help patients minimize scar formation by encouraging and providing optimal healing conditions. Proper wound care directly impacts the way skin heals and thereby, scarring minimization can be achieved, or in some cases, scar formation can be prevented entirely but it is quite complex in full-thickness wounds. 

Following is everything that you need to know about scar management:

What is Scar Tissue?

Scarring is a normal part of the wound healing process due to the presence of a tissue injury. When a patient occurs a wound, the body goes through the various stages of wound repair including re-epithelialization with the generation of granulation tissue. Smaller wounds heal quickly with minimal scarring as the tissue repair and resolution are inclusive while in case of severe injuries lead to the generation of dense masses of granulation tissues in the healing phase. 

Causes of Scar Tissue Formation

When an injury occurs, the body’s natural response is to start the tissue repairing process and heal the wound. However, the complexity of tissue healing can vary depending on the type of wound. For example, smaller wounds with 2 mm in thickness normally heal quickly without leaving scarring if there are no associated complications. While in the case of deeper, more severe, and slower healing wounds like chronic wounds, there can be varying degrees of scar tissue. 

Types of Scars

Based on the extent, severity, duration, and appearance, the scars can be divided into the following categories:

1. Keloids - Scars that are progressively larger than the wound itself that caused the injury in the first place. Like other types of scar tissue, they develop due to excessive deposition of collagen and can be visible up to a year after an injury occurred. They intrude on the surrounding area of skin tissue resulting in skin & emotional distress, causing itchiness and pain. Areas that are having sufficient blood supply like the ear lobe or the presternal area are more prone to develop keloids. They share the same color as the unaffected skin and form unattractive claw-like scars on the healed skin of susceptible individuals. 
   
   
2. Hypertrophic Scars - Prolonged inflammation leads to excessive collagen accumulation with an accelerated adhesiveness and contractility of the scar. They are raised and firm in appearance and may be painful, causing prohibited movements. Hypertrophic scars develop frequently from wounds occurring on the chest, upper back, or shoulder, for example, cuts, burns, bruises, and body piercings, etc. However, they can form anywhere on the body. It may include blood vessels and nerves that increase the chances of repeated trauma and sometimes pain. 
   
   
3. Wound Contractures - The tighter and thicker scar tissue than the surrounding skin leads to the formation of contractures. They can cause restricted movements and stress in carrying out normal daily activities, especially if the scar is close to a major joint such as a knee. This is perhaps the most complicated form of scarring as it can affect limb functionality also. If the patients notice any signs of these scars, they should contact wound care at the bedside.

What Are The Risk Factors Of Scarring?

Factors that can contribute towards the development of scarring include the following:

• Age. older-age individuals are more prone to develop worse scarring
• The presence of an infection that can delay the wound healing
• Trauma to the skin
• Dermatological condition 
• Genetics
• Chronic diseases 
• Bacterial colonization
• Systemic inflammation can increase the risk of developing hypertrophic scars or keloids
• Hypertension

Scar Treatment Options

1. Pressure Therapy

In this therapy, the pressure is applied with a pressure garment over the injury site while it is covered with a dressing to reduce a scar or prevent a keloid from developing. The use of pressure garments can be continued even if the dressings have been removed. It will inhibit scar formation.

2. Use of Moisturizers, Ointments, Gels, and Creams

Bedside Care Specialist USA can recommend applying moisture at least twice daily to improve wound flexibility and heal the area. Plus, Silicone gel and sheets applied after a wound close contribute towards decreasing scar tissue size, reducing wound site irritation, redness, and stiffness. Moisturizing agents are quite beneficial for patients who are at risk of developing wound contractures. Apart from this, regular exercise may also be recommended. 

3. Polyurethane Dressings

These moisture-based dressings made of polyurethane can be used to decrease scar stiffness, itchiness, and extent. 

4. Laser or Other Light Treatments

These therapies can be used to decrease the probability of complex scar formation, as well as associated pain, redness, and itchiness at the wound site. These treatments are quite popular in treating scars as they can limit raised scars, keloids as well as the appearance of scars. They also help reduce scarring after surgery, and swelling of the scar.

5. Cryosurgery

This treatment eliminates scars by applying an extremely low temperature that destroys scar tissue. It further reduces the size, pain, itchiness, stiffness, and improves scar pigmentation.

6. Scar excision

In this treatment option by Wound Care in Riverside, the scars can be removed by performing traditional surgical techniques that reduce the size of a keloid or boost mobility if a wound causes it. To get the best results, surgical treatment should be incorporated with the pressure dressing as it diminishes scar tissue reformation. 

7. Other treatments

Other treatments for scar management include radiation, Corticosteroids Injections, 5-Fluorouracil, Bleomycin, vitamin supplements, etc.

An Overview To Complex Wounds - Symptoms, Risk Factors & Treatment

Complex wounds are difficult to heal and pose a significant challenge for health care facilities. They make the treatment difficult and cause frustration, discomfort & pain not only in patients but the caregivers also. In this blog, we are explaining what Complex wounds are, their risk factors, symptoms, and treatment. 

What are Complex Wounds?

Complex wounds can be described as acute or chronic wounds that don’t heal with the conventional treatment within a standard period and causes severe damage to both the epidermal, and dermal layers of the skin along with underlying tissues. 

For example, when a body suffers any injury, the first step towards treatment is cleaning the wound and applying a suitable bandage to protect it from any infection. Within a few weeks, the skin heals itself. However, there are certain situations where the wounds have difficulty in healing promptly. These heard-to-heal wounds are known as “Complex Wounds”.

A complex wound may present any of these following factors:

• An open sore or injury which is slowly healing and not responding to the traditional treatment.
• The presence of an infection
• Sores on the lower legs
• Associated with chronic medical conditions 
• Compromised blood flow to the affected area with tissue necrosis
• An ulcer that exposes muscle or bone etc.

If a person is having any of these conditions, he/she should immediately contact Wound Care in Orange County to discuss the treatment and preventive measures. Though every complex wound is not necessary to be a chronic wound in duration, if left untreated, it can result in serious deformity and disability. Various healthcare providers face clinical difficulties in providing suitable care for patients suffering from complex wounds, these injuries can bring financial stress for them.

Types of Complex Wounds

There are different types of complex wounds depending on their duration and symptoms. Here they are as follows:

• Pressure wounds due to the prolonged pressure on a part of the body, eg. surgery or limb fracture, etc.
• Venous insufficiency ulcers, and arterial wounds from peripheral blood vessel diseases
• Infected wounds
• Moisture-associated wounds
• Diabetic foot ulcers due to poorly controlled diabetes
• Complicated surgical wounds 
• Wounds related to vasculitis and immunosuppressive therapy that prevents healing with traditional treatment etc.

Risk Factors For Complex Wounds

The major factors that contribute towards the development of complex wounds include the following:

• Severe tissue injury/massive skin loss
• Wound infection
• Presence of comorbidities and other wound-related conditions
• Longer wound healing period 
• Disrupted blood flow
• Poor health
• Medical side effects 

If any patient is having any of these risk factors that can increase the chances of developing complex wounds, they should immediately book a bedside appointment with wound doctors in California. Let’s read about these contributory factors in detail.

Severe Tissue Injury/Massive Skin Loss

When a large area of the skin and subcutaneous tissue gets damaged, the wound becomes difficult to treat and requires a significant amount of time to heal through the several phases of wound healing. The small wounds can be treated easily by doctors but if a large area of the skin is damaged, it becomes complex to treat. Therefore, the more extensive & larger the damage suffered by the patient, the more chances there are for developing wounds into complex wounds. 

Wound Infection

The presence of infection in the wound site is one of the common challenges in overall wound healing and the development of complex wounds. Therefore, in case the wound is infected, it must be treated immediately to further prevent severe damage. Only when the infection is removed, the skin will be able to regenerate. Bacterial and fungal infection within wound sites results in the breakdown of healing tissues, delayed granulation, and wound closure. It slows the healing process and creates a barrier to tissue closure. Thereby, if a patient sees any symptoms of infection, they must call wound care specialists in Los Angeles.

Presence Of Comorbidities And Other Wound-Related Conditions

Many chronic medical conditions as well as their treatment modalities lead to the development of complex wounds in the patients. For example, peripheral vascular disease, immunosuppression or acquired immunodeficiency, diabetes, medications or radiotherapy, etc. All these comorbidities and chronic conditions increase the risks of complex wounds. So, if the patient is suffering from any of these conditions, they should disclose the same to wound care Los Angeles. Plus, other wound-related conditions such as Osteomyelitis, peri-wound dermatitis, etc. negatively affect the wound repair process.

Longer Wound Healing Period

Wounds that last more than three months in duration are generally described as complex wounds. This is because of the high possibilities of pathological transformation from any type of physical trauma or infected wounds.

Disrupted Blood Flow

Proper blood circulation is extremely necessary to accelerate wound healing. The blood carries sufficient nutrients to the affected site and helps with healing. The inefficient blood supply delays the overall healing process. Thereby if any patient has decreased or limited mobility, they are at higher risks of developing chronic wounds.

Poor Health

If a patient has poor nutritional support and has other medical conditions such as diabetes or peripheral arterial disease, they are more prone to develop complex wounds. Patients with other medical conditions have decreased capacity to heal the wounds as compared to those patients without these conditions. Similarly, the patients who smoke, or drink excessively, or are overweight suffer from delayed wound healing.

Medical Side Effects

If a patient is on certain medications such as corticosteroids and immunosuppressants, they can have delayed wound healing. These certain medications slow the wound healing process and decrease the skin’s ability to fight against infection while regenerating. 

Diagnosis of Complex Wounds

The diagnosis of complex wounds requires a few sets of processes including:

• Documenting the patient’s comprehensive medical history.
• In-depth clinical examination of wound/periwound lesions
• Various laboratory tests using blood samples wound swabs, and biopsy samples
• Radiological diagnostic techniques (CT, MRI, Wound Ultrasonography, etc.)

Treatment Options for Complex Wounds

Though the treatment approaches used in treating complex wounds differ between the various categories, wound care professionals use the following steps in managing complex wounds. Here they are as follows:

• Debridement
• Hyperbaric oxygen therapy
• Surgical repair
• Negative pressure wound treatment
• Preventing infection with antibiotics, antifungal preparations
• Local wound care including wound cleansing, and dressing
• Treating comorbid medical states using medications or surgery etc.
• Dietary changes etc.

Complex wounds can be frustrating for both the health care providers and patients but the early identification of risk factors and suitable treatment plan can improve the chances of quicker wound healing.