Troublesome Scars
What are they?
Scarring is a natural part of the healing process. With the exception of very minor lesions, every wound (e.g., after accident, disease, or surgery) results in some degree of scarring. Scars are necessary to close a wound to prevent infection and to make a permanent barrier from the outside world.

Scar tissue forms when layers of collagen build a strong bond to the normal skin on each side of the wound and then meet in the middle. Collagen is a type of fibre made of protein and is found in all normal tissue. Undamaged skin tissue has collagen woven in a pattern like a basket weave. Scar fibres are different. They knit together in straight lines making them much less elastic than the basket weave type.

Scars start out quite red and raised for up to 2 years after the wound has closed. Over time a normal scar will flatten and turn white and is much less visible. Generally it is best to forget about them but when thing go wrong they can be a real nuisance. 
Troublesome Scars
There are several ways your scar might develop. The flattened kind give little trouble and do a very good job replacing the normal skin tissue. However, sometimes the collagen layers don't stop growing and form thick over growth making either a keloid scar or a hypertrophic scar.

Keloid scars often have the following characteristics:

  1. Raised above the normal skin levels
  2. Itchy and painful against clothing or other textures, hard and soft
  3. Are larger than they needed to be to repair the wound
  4. They can be tight and tether the normal skin restricting movement especially if near a joint
  5. Most likely occur in the upper arm and shoulder
  6. Usually settles a little over the first 2 years

Hypertrophic scars often have the following characteristics:

  1. Red and raised above the normal skin levels 
  2. Itchy and painful against clothing or other textures, hard and soft
  3. Are thicker than they needed to be to repair the wound
  4. They can be tight and very in-elastic and pull normal skin restricting movement in muscles  or if near a joint
  5. Can appear anywhere where the wound is
  6. Can continue to grow for up to 5 years

Deep scars that cross through the skin into muscles, tendons, veins and nerves can bind them all together. A traumatic injury such as an open fracture can produce a long zig zag scar and surgery usually produces a straight scar, for example following tendon repairs or carpal tunnel release.Deep pressure scar massage for 2 or more years in very important to encourage the scar to soften and be more flexible. Exercising the other wounded tissues, once they are strong enough, will encourage them to stay free from sticky collagen fibres.

Remember, scar tissue is not normal tissue and is the body's only mechanism to replace lost tissue. Scars are much more sensitive to UV light and can burn easily, even mature scars. Hair follicles do not grow back within scars either and scars do not sweat. 
Troublesome Scars
Helping scars to heal requires patience and consistency. Patience because scar healing is slow and consistency because scars need daily treatment.

There are lots of gels and creams that claim to help scars to look as much like the original skin as possible. However, as scar tissue is tight and in-elastic it generally responds well to any cream that will moisturise it.

The best total treatment is actually a combination of  some or all of the following:

  1. Silicone sheets
  2. Silicone gels
  3. Compression garments
  4. Scar massage
  5. Therapeutic ultrasound
  6. Kinesio taping
  7. Nutrition and hydration
  8. Exercise of nearby joints and muscles to stretch the scar tissue

Some people like to try laser treatments which may be beneficial in some situations, but learning how to perform a good home scar routine every day will achieve excellent results.

Very raised scars may require surgery to remove the excessive scar tissue and this is performed by a plastic surgeon
Troublesome Scars
What can Hand Kinetics do?
During the recovery of your scar it is important to remember it happens over many months and the scar will go through several healing phases. Treatment at Hand Kinetics will depend on the phase of healing of your scar at that time.

At Hand Kinetics we can show you how to care for your scar from the outset to help it heal flat and free from adhesion to other healthy tissue. With suitable treatment your scar will be able to mature and disappear.

Treatment usually focuses on how you can mobilise the scar early with massage techniques and on using silicone gels and creams to wear to speed up healing.

In some cases the scar "tethers" meaning it pinches or tugs on healthy skin and other structures beneath the skin surface. Therapeutic ultrasound can help to stimulate alignment of new scar tissue to help keep it smooth and supple. 

If you have burns scars these require very careful management and the use of compression garments worn for months. Hand Kinetics do not measure for these special garments but can point you in the right direction if necessary. Please telephone if you have any special requests and we will be happy to help you. 

Hand Kinetics Telephone: 0044 28 417 72301

15 The Avenue, Burren, Warrenpoint. Co. Down. BT34 3XJ

0044 28 4176 7238
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