Scar management – The role of dressings with Safetac
Resolution of inflammation during healing minimizes scar formation, whereas persistence of the primary insult results in continued inflammation and chronic healing1. Continued fibrosis in the skin leads to scarring and, potentially, disfigurement as a result of progressive deposition of matrix. The most commonly encountered scar types include hypertrophic, keloid, widened, and contracture2,3. Whatever the type, scars are disfiguring and can interfere with the normal functioning of the primary organs that they affect, e.g. the skin and its associated appendages.
Hypertrophic scars are seen in approximately 50 percent of wounds after surgery and more than 50 percent of healed deep burns4. They are generally red, raised and itchy and appear within the boundaries of wounds. Keloid scars, although somewhat similar in appearance to hypertrophic scars, generally extend beyond the borders of the original scar: they affect all races but are 15 times more likely to occur in patients with darker skin. The incidence of keloid scars is about 10 percent in wounds in the high-risk groups. Contracture scars are particularly severe and usually occur as a result of losses of large areas of skin, e.g. following burn injuries and in badly aligned surgical wounds not corresponding to Langer’s lines. These scars cause the edges of the skin to pull together, affecting the adjacent muscles and tendons, thereby restricting normal movement and resulting, in some cases, in the need for z-plasty or skin grafting. Widened scars appear when surgical wounds are stretched as a result of skin tension during the healing process. They are generally pale in colour, flat, soft and symptomless, but can be aesthetically displeasing1.
Topical silicone gel sheeting has been used successfully for over 20 years to treat hypertrophic and keloid scars5 and is supported by numerous clinical evaluations and international clinical recommendations on scar management6. It has been proposed that there are two mechanisms for the effectiveness of silicone sheets in the prevention and treatment of hypertrophic scarring. Firstly, silicone sheets limit moisture loss from the skin surface and aid in hydration and secondly, the sheets do not limit the access of oxygen to the surface of the skin due to their exceptionally high permeability. This causes a localised increase in oxygen tension leading to a down-regulation of signals that stimulate growth near the skin surface thus preventing/reducing scar formation7.
Mepiform®, a soft silicone scar dressing with Safetac®, has been evaluated in a number of studies for the treatment of hypertrophic scars. Saulsberry et al8 report on four cases where Mepiform was utilised for scar management following surgical incisions and burns. Throughout the treatment period (at least six months for each patient), the dressing maintained a low profile and remained in situ under a compression garment without edge roll or interfering with joint mobility. The scars, originally hyperpigmented, returned to a more normal pigmentation with a smoother and more flexible nature8. The use of Mepiform was also associated with a significant improvement in hypertrophic scars in a study involving 12 patients9. An observational study undertaken to evaluate the effectiveness of Mepiform on post-burn and other traumatic scars of both paediatric and adult patients (n=87) in an outpatient setting found that the adherence and simplicity of the application of Mepiform appear to enhance patient compliance, as well as improving scar quality and patient comfort10. These findings are also reflected in other case study evaluations of Mepiform11.
In an RCT on 11 patients with postoperative hypertrophic scars, participants were randomly allocated to treatment with Mepiform or ‘left alone’ management (Table 13). Patients treated with Mepiform showed greater and more rapid improvements than those in the ‘left alone’ group, as measured by the Vancouver Scar Scale. Commenting on their results, the authors conclude that, as Mepiform is self-adhesive and its use limits damage to the stratum corneum on removal, it gives it an added value compared with non-adhesive silicone gel dressings12. This has been further demonstrated in a case study in which the early use of Mepiform successfully prevented scarring of a severe forehead laceration5. Mepiform has also been reported to successfully treat scars after breast operations13.