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= = = =疤痕管理“的目标:“改变物理ical an mechanical properties of the scar by influencing the scar maturation process. Also promoting tissue strength and gliding by preventing adhesions. '''Scar [[massage]]:''' During the proliferative stage massage has a beneficial role in collagen synthesis, as it prevents adhesions and helps in collagen synthesis. Also this mechanical stress when applied to the intermolecular bonds, helps in realigning collagen. '''[[Splinting for Burns|Splinting]]:''' Splinting can be used at all stages of wound healing, to immobilize at the earlier stages and with the aid of passive or active stretches to modify collagen alignment. Static and dynamic splinting can alter the viscoelastic properties of tissues thus it can elongate and stretch tissues over time. '''Silicon gel:''' Silicone gel through sheeting and elastomers are said to have a hydrating effect on the scar. It helps to soften and elongate a scar by increasing the pressure, temperature and in turn blood flow to the scar. '''[[Therapeutic Ultrasound|Ultrasound therapy]]:''' The known effect of ultrasound is to promote healing in the inflammatory and proliferative stages. It stimulated the synthesis of growth factor that in turn increase the strength and elasticity of the collagen fibers formed, '''Laser:''' Laser inhibits collagen and improves keloid and hypertrophic scarring. It improves pruritus but ha no effect on he cosmoses of the scar. '''[[Extracorporeal Shockwave Therapy (ESWT)|Extracorporeal shock wave therapy (ESWT)]]:''' Extracorporeal shock wave therapy (ESWT) is a noninvasive treatment that influences scar remodelling through fibroblast regulation. According to Patient and Observer Scar Assessment Scale (POSAS), ESWT showed promising results in hypertrophic scars in a study that provided data to support further investigations into the use of ESWT for the treatment of hypertrophic scars.<ref>Chuangsuwanich A, Kongkunnavat N, Kamanamool M, Maipeng G, Kamanamool N, Tonaree W. Extracorporeal Shock Wave Therapy for Hypertrophic Scars. Archives of Plastic Surgery. 2022 Jul;49(04):554-60. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9340180/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9340180/Extracorporeal Shock Wave Therapy for Hypertrophic Scars] </ref> '''Pressure Therapy:''' When used for edema management and cosmoses in case of keloid and hypertrophic scars. These garments inhibit collagen synthesis in a remodeling scare through a mechanism that is unknown. Pressure therapy can reduce the scar height and erythema when applied for 23 hours per day for 12 hours. This should be applied at 20 to 30 mmHg and replaced every 2 to 3 months. This reduce abnormal pigmentation and accelerates scar maturation<ref>Sharp PA, Pan B, Yakuboff KP, Rothchild D. [https://scholar.google.com/scholar_url?url=https://academic.oup.com/jbcr/article-abstract/37/4/255/4582148&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=8996168019499629399&ei=RmQxYpLPIojwyAS2o4mYAw&scisig=AAGBfm11t3foWXZqFwWnOPiXM2GdDm05rA Development of a best evidence statement for the use of pressure therapy for management of hypertrophic scarring]. J Bur Care Res. 2016 Jul 1;37(4):255-64.</ref> '''Pressure garments:''' This is sued in case of more widespread scarring as in case of burns patients.<ref name=":1">Monstrey S, Middelkoop E, Vranckx JJ, Bassetto F, Ziegler UE, Meaume S, Téot L. [https://scholar.google.com/scholar_url?url=https://www.sciencedirect.com/science/article/pii/S1748681514001739&hl=en&sa=T&oi=gsb-ggp&ct=res&cd=0&d=14334434724093097342&ei=LmQxYvieFZz2yASmtKGwCg&scisig=AAGBfm3OFxHHB4tAMs0NPDPzWJt--MUbLQ Updated scar management practical guidelines]: non-invasive and invasive measures. J Plast Reconstr Aesthet Surg. 2014 Aug 1;67(8):1017-25.</ref> '''Steroids:''' An intraleisonal injection of a steroid improves the scarring. This is painful and is suggested with other routine treatments.<ref name=":0" />
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