215

© The Author(s) 2020, corrected publication 2021L. Téot et al. (eds.), Textbook on Scar Management, https://doi.org/10.1007/978-3-030-44766-3_25

Treatment of Immature Scars: Manual MassagesDocteur N. Frasson, Marie Valange, Isabelle Almeras, Mathieu Izquierdo, and Gwenola Ster

Contents

25.1 Background – 216

25.2 Introduction – 216

25.3 Indications of Manual Massages – 216

25.4 Description of the Techniques – 21625.4.1 Morice Orthodermic Stretching – 21625.4.2 Punctual Crushing – 21625.4.3 Static Fold – 21625.4.4 Palpate-Rolling – 21725.4.5 Efficacy – 217

25.5 Conclusion – 217

Bibliography – 217

25

The original version of this chapter was revised to update the authorship. The correction to this chapter can be found at https://doi.org/10.1007/978-3-030-44766-3_65

216

25

25.1 Background

Scar massages are used to improve skin qualities in terms of flexibility, adhesions, pruritus, and pain. The specific techniques are not always mastered by all the therapists. Indeed pathological scars can appear follow-ing strong massage movements or too long sessions dur-ing the inflammation stage. The techniques must be controlled and take into account the inflammation, the appearance, and the localization of the scar.

25.2 Introduction

Care of the burn skin and scars requires specific treat-ments to reduce and control the inflammation stage and its consequences [1, 2]. Adapted rehabilitation technique restores flexibility and limits esthetic and functional sequelae. The treatment will progress and be adapted throughout the scar maturation process. Several specific manual massages are part of the treatment but have to be applied respecting the inflammation, the fragility, and the localization of the scar [3, 4, 5].

25.3 Indications of Manual Massages

Manual massages allow to improve cutaneous mobility compared with the deep plan and its elasticity. They are indicated on burn scars but also in case of traumatic or surgical scars [6].

They can be started as soon as the scar tissue is epider-mized and solid and allows to support specific manual techniques. The massages are contraindicated when the tis-sue is thin and hyper-inflammatory. When the skin is frag-ile and presents a vitropression test less than 1.2 seconds, the massages will be realized at first around the scar [7, 8].

25.4 Description of the Techniques

25.4.1 Morice Orthodermic Stretching

Orthodermic stretchings such as they were described by René Morice are compatible with an inflammatory skin. Indeed the technique can be summarized by a fixed pulpaire pressure associated with a moderated stretch-ing supported in the inverse direction of the retraction. This kind of massages is frequently used on the face and dorsal side of the hand.

25.4.2 Punctual Crushing

The punctual crushing is also used during the inflamma-tory stage and allows to crush the edges of grafts or hypertrophic scars. The pressure is moderated, vertical, and realized with the pulp of one or several fingers. The pressure can be circular but without practicing however of friction or lifting fingers.

25.4.3 Static Fold

Statics folds are realized during the inflammation stage on a solid epidermis and when the vitropression test is close to 2 seconds. They improve various plans if sliding and have an action on the suppleness of the skin.

D. N. Frasson et al.

217 25

According to the surface or area to be treated, they are realized between two fingers or more globally between two hands. There are no movements of friction during this care.

25.4.4 Palpate-Rolling

When the vitropression test gets closer to 3 seconds, the static fold evolves in rolled fold. This also significantly softens the deep plans and fibrosis scars. Palpate-rolling has also an interest to raise adhesions. It is crucial to observe the scar tissue before, during, and after the massage treatment.

25.4.5 Efficacy

The massages are widely used within the care and reha-bilitation of burns and scars.

The techniques have a role in the improvement of the characteristics and evolution of the scar.

25.5 Conclusion

Treatment of skin and scar following burn injuries must be performed with caution and requires the input of the whole multidisciplinary team. It is necessary to align the treatment according to the stage of scar maturation. The inflammation of the scar is the main factor to con-sider to guide the therapist’s treatment [9].

Bibliography

1. Anthonissen M, Daly D, Janssens T, Van den Kerckhove E.  The effects of conservative treatments on burn scars: a system-atic review. Burns. 2016;42(3):508–18. https://doi.org/10.1016/j.burns.2015.12.006. Epub 2016 Jan 15.

2. Gavroy JP, Poveda A, Oversteyns B, Plantier G, Rouget D, Griffe O, Teot L, Costagliola M, Ster F. Intérêt du "test de vitro pression" dans le suivi des cicatrices de brulures a partir de 50 observations. Ann Medit Burns Club. 1995;VIII(1).

3. Cho YS, Jeon JH, Hong A, Yang HT, Yim H, Cho YS, Kim DH, Hur J, Kim JH, Chun W, Lee BC, Seo CH. The effect of burn rehabilitation massage therapy on hypertrophic scar after burn: a randomized controlled trial. Burns. 2014;40(8):1513–20. https://doi.org/10.1016/j.burns.2014.02.005. Epub 2014 Mar 12.

4. Shin TM, Bordeaux JS. The role of massage in scar management: a literature review. Dermatol Surg. 2012;38(3):414–23. https://doi.org/10.1111/j.1524-4725.2011.02201.x. Epub 2011 Nov 7.

5. Roques C, Téot L, Frasson N, Meaume S. PRIMOS: an optical system that produces three-dimensional measurements of skin surfaces. J Wound Care. 2003;12(9):362–4. PMID: 14601231.

6. Ault P, Plaza A, Paratz J. Scar massage for hypertrophic burns scarring-a systematic review. Burns. 2018;44(1):24–38. https://doi.org/10.1016/j.burns.2017.05.006. Epub 2017 Jun 29.

7. Najafi Ghezeljeh T, Mohades Ardebili F, Rafii F, Manafi F. The effect of massage on anticipatory anxiety and procedural pain in patients with burn injury. World J Plast Surg. 2017;6(1):40–7.

8. Najafi Ghezeljeh T, Mohades Ardebili F, Rafii F.  The effects of massage and music on pain, anxiety and relaxation in burn patients: randomized controlled clinical trial. Burns. 2017;43(5):1034–43. https://doi.org/10.1016/j.burns.2017.01.011. Epub 2017 Feb 4.

9. Finnerty CC, Jeschke MG, Branski LK, Barret JP, Dziewulski P, Herndon DN. Hypertrophic scarring: the greatest unmet chal-lenge following burn injury. Lancet. 2016;388(10052):1427–36.

Treatment of Immature Scars: Manual Massages

218

25

Open Access This chapter is licensed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons. org/licenses/by/4. 0/), which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appro-priate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

The images or other third party material in this chapter are included in the chapter’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the chapter’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

D. N. Frasson et al.