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Silicone Gel Products and Scar Integrity

Healing Process. Inflammatory PhaseFibroblastic-Repair PhaseMaturation-Remodeling Phase. Inflammatory Phase. Remove dead tissueVasoconstrictionVasodilation Platelet plugFibrinogen to fibrinSigns of inflammation . Prentice WE. Arnheim's Principles of Athletic Training. 11th ed. New York: McGraw-Hill; 2003..

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Silicone Gel Products and Scar Integrity

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    1. Silicone Gel Products and Scar Integrity Kathleen B. Mitchell, SPT, VATL, ATC Doctoral Student, Physical Therapy Program Shenandoah University Barbara H. Long, MS, VATL, ATC Chair, Health & Exercise Science Department Director, Athletic Training Program Assistant Professor, Health & Exercise Science Bridgewater College

    2. Healing Process Inflammatory Phase Fibroblastic-Repair Phase Maturation-Remodeling Phase

    3. Inflammatory Phase Remove dead tissue Vasoconstriction Vasodilation Platelet plug Fibrinogen to fibrin Signs of inflammation

    4. Fibroblastic-Repair Phase Angiogenesis Granulation tissue Fibroblasts Collagen formation Signs of Proliferation

    5. Maturation-Remodeling Phase Remodeling of collagen Scarring Signs of maturation

    6. Hypertrophic Scar Scars are end point 2-3 years Collagen lays down prematurely

    7. Research Questions Is there value in using silicone gel products with post-surgical wounds to enhance scar pliability and visual appearance? One product better than another?

    8. Silicone Gel Mechanism unknown Borgognoni (2002) says silicone induces hydration of skin surface Brissett (2001) says silicone decreases capillary action, inflammatory mediators and collagen production Nikkonen (2001) found silicone gel reduced hypertrophic scarring

    9. Silicone Gel and Hypertrophic Burn Scars Examine application of silicone gel sheets affected blood flow in burn scars Vancouver Scar Scale No change in blood flow Increased surface temperature Musgrave et al (2002)

    10. Silicone versus nonsilicone gel dressings: a controlled trial. To compare silicone and nonsilicone gel dressings in treatment of scars Scar size, hardness, symptoms, color All measured parameters were significantly reduced Silicone and nonsilicone equally effective de Oliveira et al (2001)

    11. Scar Treatments Smith & Nephew CICA CARE® Adhesive Gel Sheets Johnson & Johnson’s BAND-AID® Brand Scar Healing Strips CURAD® Scar Therapy™ Cosmetic Pads

    12. http://wound.smith-nephew.com/us/node.asp?NodeId=3023 Smith & Nephew CICA CARE® Adhesive Gel Sheets $66.15 for 4ľx6” sheet Lasts ~2 weeks on large scars and ~4 weeks on smaller scars Directions for use: 4 hrs/day for 2 days 8 hrs/day for 2 days Inc @ 2 hrs/day Goal: 12-24 hrs day Cleaned twice daily

    13. www.bandaid.com Johnson & Johnson’s BAND-AID® Brand Scar Healing Strips $19.99 for 7 strips Lasts 3 weeks Directions for use: Wear 23 hrs/day Clean daily Same strip for 3 days

    14. www.curad.com CURAD® Scar Therapy™ Cosmetic Pads $18.89 for 21 pads Lasts 3 weeks Wear 12 hrs/day Change pad daily

    15. Product Expense

    16. Methods 20 post-surgical patients IRB Approval 3 cm long, sutures or staples, 6 week rehab 5 patients for each treatment and control selected randomly Manufacturer's directions

    17. Methods Assessed weekly for 6 weeks by same rater Digitally analyzed Clinical Scar Assessment by Beusang et al and Vancouver Scar Scale with amendments by Baryza and Baryza

    19. Results 2.6 for CICA CARE® group 2.8 for BAND-AID® group 3.2 for CURAD® group 1.3 for control group All products improved in patient’s eyes

    20. Statistical Analysis Repeated measures ANOVA 1st week compared to 6th week was statistically significant, p=.000 Comparison among different products was not determined significant due to some of the control group patients still undergoing treatment, p=.654

    21. Week 1 and Week 6 Profile Plots

    22. Control and Treatment Profile Plots

    23. CURAD®’s Scar Therapy™ Cosmetic Pads

    24. BAND-AID® Brand Scar Healing Strips

    25. CICA CARE® Adhesive Gel Sheets

    26. Conclusion Over the counter products are effective Over the counter products are relative inexpensive CURAD® had the most improvements and was the cheapest treatment product of the three Something was better than nothing

    29. Questions??

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