This week’s Guest Blog Post comes from our own Jessica Cesario, OT/L, CHT. Jessica has been at Elite since 2013 and has over 24 years of experience as a licensed Occupational Therapist. She’s spent the last 13 years working as a Certified Hand Specialist (CHT) and is an expert in the treatment of the upper extremity (shoulder, elbow and hand) and hand therapy. We’re very fortunate to have her as a member of our skilled therapy team and today she shares some tips and tricks for managing scars following surgery or injury.
Tips & Tricks for Scar Management
After an injury, trauma, burn or surgery, the body responds by forming scar tissue. Scar formation is a normal part of the healing process, but not all scars are the same. Scar tissue may involve superficial skin or it may involve deeper tissues beneath the skin including nerves and tendons. In the first 4-6 weeks of healing, scars become larger and red but this is a normal phase of healing. Scar formation is part of the last phase of wound healing, the maturation or remodeling phase. This phase can last from 21 days to 2 years. Active scars may be firm, raised, red, thick and can feel sensitive or even restrict motion or function.
Wound care and scar management have a direct impact in how your skin heals. With proper wound care, it is possible to minimize scarring and in some cases prevent a scar entirely. In full-thickness wounds, prevention of scarring is not possible.
There are several non-invasive scar management interventions and treatments used by Hand Therapists.
- Pressure Therapy involves applying a pressure garment over dressings to a wound while it is healing. This treatment is used more in widespread scarring, especially after burns.
- Moisturizers, when applied at least twice daily, can improve flexibility and strength of scar.
- Silicone gel, sheet or ointment can be applied after wound closure to reduce the scar’s size, firmness, redness, itching or stiffness. They can also prevent the scar from being raised. The silicone sheet can be washed and re-used and is best used 12-24 hours/day for up to 3-6 months.
- Manual massage helps to decrease sensitivity and itching and to smooth the scar surface. It can also loosen deeper structures that feel “stuck”. Normal skin can be lifted and moved in all directions. Massaging the scar helps it to move in the same way as normal surrounding skin. Any over the counter cream such as Vaseline, cocoa butter or hand cream may be used. Begin with light pressure and progress to deeper, firmer pressure. Massage in circular, vertical and horizontal directions for 10 minutes, 2-3 times per day. Another trick is to use a non-slip material directly over the scar and massage in the same multidirectional pattern as you would using the cream. The non-slip material will “grip” the skin and help mobilize the scar.
- Early controlled exercise programs can prevent stiffness of nearby joints and keep tendons gliding under the skin.
- Taping or Wrapping of the scar can help reduce swelling and tension. Most commonly, kinesiology tape is used as it applies gentle pressure to scars. This helps to decrease the likelihood of scar becoming thick and raised.
- Vibration and rubbing the scar with various textures can help to decrease the sensitivity. Scar hypersensitivity occurs when nerves in the skin and deeper tissues are affected by injury or surgery. The scar can also be submerged in slightly abrasive particles. This is due to decrease sensitivity to allow the skin and nerves to tolerate the normal forces of everyday activity. This scar desensitization process can take up to 4 months and can be initiated as soon as skin and repair tissues have healed.
- Avoid sun exposure while scar is healing as it may cause the scar to turn darker color than the surrounding skin. Applying sunblock of SPF greater than 35 is recommended for the first year.
If you or someone you know is need of physical therapy for an upper extremity surgery or injury or hand therapy and the unique skill set of a Certified Hand Specialist, please contact us to schedule an appointment with Jessica.
JESSICA CESARIO, OT/L, CHT
Jessica graduated from the State University of New York at Buffalo in 1996 where she earned a Bachelor of Science degree in Occupational Therapy. She participated in advanced professional study of Hand and Upper Extremity Rehabilitation at Tufts University and became a Certified Hand Therapist in 2010. She has been practicing for 24 years, specializing in rehabilitation of the elbow, wrist and hand for the last 13 years. Jessica joined the Elite therapy team in 2013. She is experienced in custom splinting and treating various upper extremity conditions including fractures, sprains and strains, arthritis, tendonitis, tendon and nerve repairs, and work and sports related injuries. Jessica grew up in Rochester, NY and was a high school athlete, playing soccer and running track. She moved to the Boston area in 1999. She enjoys cooking, running and spending time outdoors with her family and dog.