Subjective Tools for Burn Scar Assessment: An Integrative Review.

OBJECTIVE: To review the clinical and scientific literature on the subjective ways of assessing burn scars and describe their main characteristics. DATA SOURCES: The Latin American, Caribbean Health Sciences Literature, Nursing Database, PubMed, CINAHL, and Scopus and Web of Science databases were used to search for studies published between 2014 and 2018 using descriptors in Portuguese, Spanish, and English. STUDY SELECTION: After establishing the research question and the location and definition of the studies, as well as accounting for differences among databases and application of filters based on inclusion and exclusion criteria, 886 references remained. DATA EXTRACTION: Investigators reviewed the titles and abstracts of the sample and selected 188 relevant studies for full review. DATA SYNTHESIS: Twenty-six subjective forms of assessment were found; most research concerned the Patient and Observer Scar Assessment Scale and the Vancouver Scar Scale. CONCLUSIONS: The Patient and Observer Scar Assessment Scale and the Vancouver Scar Scale are the most common scales for assessing burn scars and have similar evaluation points such as vascularization, pliability, pigmentation, and height, which are the main parameters that contribute to the general assessment and severity of a scar. There is a need to improve instructions for application of the scales to facilitate better understanding and improve agreement among evaluators.

[Observational study of the second-line nursing consultation in wounds and scarring: A didactic situation under construction]. / Étude descriptive de la consultation infirmière de deuxième ligne en plaies et cicatrisation : une situation didactique en construction.

Introduction and objective : In the activity of wound and scar nurses (Infirmières spécialisées en plaies et cicatrisation ; ISPC), the "second-line" nursing consultation is also an opportunity to offer applicants the opportunity for training. This study is part of an exploratory perspective, with the objective of questioning the didactic dimension of this type of consultation. To address the issue, attention is focused on the analysis of the ISPC's activity.Material and method : Two simple self-confrontation interviews of an ISPC are analyzed on the basis of video consultations.Results and discussion : Although the results identified remain incomplete since the interviews were based on a single individual, this article shows how the ISPC, after the interviews, is able to formulate future adjustments to their practice. The first avenue is to highlight a necessary transformation of the discourse of the ISPC during consultations. The second is to question the modality of the post-consultation follow-up.

Scars: impact and management, with a focus on topical silicone-based treatments.

Many people are living with scars caused by surgery or traumatic injury. Scar prevention in the early stages of wound healing is an essential aspect of care. Ongoing scar management is generally by self-care, using non-invasive methods such as silicone sheeting and/or massage. Silicone is considered to be the first-line non-invasive, prophylactic and therapeutic measure for scar management. Nurses have a role in supporting patients with self-care of their scars as well as providing psychological support, as the impact of a scar and effect of quality of life can be significant.

Diagnosis, treatment and management of epidermolysis bullosa.

Epidermis bullosa is a genetically inherited disease in which painful blistering of the skin or mucous membranes occurs after minor trauma. It is a lifelong problem. The diagnosis should be confirmed by a specialist, preferably at a specialist unit where a treatment plan and follow-up arrangements for professionals and families can be put in place. Nurses will be involved in frequent dressings of wounds, after extra analgesia, and may need to be alert to any need for further specialist referral, especially in the case of complications such as infection, deformities, gastrointestinal strictures and possible skin cancers. Genetic counselling should also be offered to families, especially when considering the possible risks to future pregnancies.

Casos clínicos tratados con la tecnología lípido coloidal (TLC) / Clinical cases treated with tecjnology lipid colloidal (TLC)

Introducción. En este estudio se exponen casos clínicos que recogen las etiologías más frecuentes en el campo de las heridas complejas. Todas requieren un abordaje específico, además de la participación interdisciplinar de diferentes miembros del equipo. Sin embargo, en general, los planes de cura locales establecidos pueden ser bastante similares. Se les aplica la tecnología lípido coloidal (TLC) que consiste en la combinación de partículas de hidrocoloide (carboximetilcelulosa) con componentes lipídicos. Son productos con una tecnología diseñada para cada momento de la cicatrización. Objetivo. Dar a conocer nuestra experiencia en la utilización de productos con TLC en pacientes con úlceras de diferentes etiologías. Método. Se han utilizado los siguientes productos dependiendo del caso que tratar: UrgoTul® Absorb Border, Urgoclean® (mecha o placa), UrgoStart®, UrgoK2® y UrgoK2 LITE®. Estos productos se aplicaron en pacientes que presentaban cuatro etiologías de úlcera diferentes: úlcera hipertensiva, traumática, venosa e isquémica (arterial). La utilización de Urgoclean® mecha favoreció la limpieza del lecho ulceral y se aplicó Urgoclean® placa con alginato reforzado para controlar los exudados abundantes, con cobertura de UrgoTul® Absorb Border. Una vez limpios los lechos, pasamos a UrgoStart® y usamos en todo momento vendaje UrgoK2®, en los casos que precisaban terapia compresiva. A los pacientes que presentaban intolerancia a ese tipo de compresión se les aplicó el vendaje UrgoK2 LITE® (que toleraron sin problema), lo que redujo notablemente el edema y favoreció el control del exudado. Los pacientes con heridas de larga evolución se mostraron al inicio reticentes a la aplicación de nuevas tecnologías, pero, trascurridas las primeras curas, y al percibir una buena evolución, confiaron y se adhirieron al tratamiento hasta la resolución. Resultados. Se muestran casos clínicos de diferentes contextos etiológicos y personales, de los que, con un abordaje integral e interdisciplinar, junto con la aplicación de productos con TLC, se consiguió resolver la problemática. Conclusión. Los materiales utilizados han sido satisfactorios en todos los casos, con una implicación directa en la resolución de las lesiones que conllevaban un largo tiempo sin resolver y, en alguno de ellos, incluso con un diagnóstico de mal pronóstico. En la práctica clínica del cuidado de las heridas es muy importante el conocimiento y la investigación de nuevos materiales que mejoren la calidad de vida de los pacientes y reduzcan el tiempo de evolución de las lesiones. Sin olvidar que la educación para la prevención de su salud debe ser uno de los objetivos para evitar las recidivas (AU)

Introduction. This study presents clinical cases collecting etiologies that are more frequent in the field of complex wounds. All require a specific approach, as well as the interdisciplinary participation of different members of the team. But in general, established local cure plans may be quite similar. Applies them technology lipid colloidal (TLC) which consists of the combination of particles of hydrocolloid (carboxymethylcellulose) with lipid components. Products with a technology designed for every moment of healing. Objective. Show our experience in the use of products with TLC in patients with ulcers of different etiologies. Method. The following products depending on the case have been used to treat: UrgoTul® Absorb Border, Urgoclean® (rope or plate), UrgoStart®, UrgoK2® and UrgoK2 LITE®. These products were applied in patients presenting four different etiologies of ulcer: hypertensive, traumatic, venous and ischemic ulcer. The use of Urgoclean® rope favored cleaning the bed ulceral and applied Urgoclean® plate with reinforced alginate to control the abundant exudates, with coverage of UrgoTul ABsorb Border®. Once clean beds pass UrgoStart® and at all times UrgoK2® bandage, cases that required compressive therapy. Intolerance to that kind of compression applied to patients presenting bandage UrgoK2 LITE® (which tolerated without problem) which significantly reduced edema, favoring the control of exudate. Patients with ulcer of long evolution, at the start were reluctant to the application of new technologies, but after the first cures and sensing a good evolution, we get their confidence and commitment to the resolution. Results. Are displayed clinical cases of different etiologic and personal contexts that an integral and interdisciplinary approach together with the application of products with TLC, managed to solve the problem. Conclusion. The materials used have been satisfactory in all cases, with a direct involvement in the resolution of lesions which carries a long unresolved, and in any of them, even with a diagnosis of poor prognosis. In the clinical practice of the wound care knowledge and research of new materials that improve the quality of life of patients, reducing the time evolution of the lesions is very important. Not to mention that education for the prevention of their health should be one of the objectives to prevent recurrences (AU)

[Scars, physiology, classification and assessment]. / Cicatrices, physiologie, classification et evaluation.

A skin scar is the sign of tissue repair following damage to the skin. Once formed, it follows a process of maturation which, after several months, results in a mature scar. This can be pathological with functional and/or aesthetic consequences. It is important to assess the scar as it matures in order to adapt the treatment to its evolution.

[Physical therapy for scars]. / La physiothérapie des cicatrices.

Physical therapy consists notably of hand or mechanical massages, pressure therapy using various fabrics or splints, cryotherapy, laser therapy, etc. It forms part of the range of therapies used to treat pathological scars, including medical and surgical treatment. While the results are often satisfactory for hypertrophic scars, they remain uncertain for major keloids.

[The medical treatment of scars]. / Le traitement médical des cicatrices.

The medical treatment of scars follows the recommendations of experts working in this field. Traditional medical treatments include silicone, corticosteroid injections, radiotherapy, cryotherapy, 5-fluorouracil or bleomycin. Several other treatments are currently being assessed.

[Burn scars]. / Les cicatrices de brûlures.

Burns often result in extensive scars which can change the body aesthetically and/ or functionally. Rapid scarring is a sign of a good prognosis. Preventative actions such as hydration, compression, massage, posture and splints help to prevent or contain the negative evolution of pathological scars.

[Scars and lasers]. / Cicatrices et lasers.

Different lasers are used to improve scars in combination with other therapies. The pulsed dye laser is considered to be the gold standard for hypertrophic scars and keloids. Ablative laser treatments are used with atrophic scars. Ablative or non-ablative fractional laser treatments are developing rapidly due to the lower risk of infection and easier follow-up care.

[The surgical treatment of scars]. / La prise en charge chirurgicale des cicatrices.

Scars can be functionally or socially disabling. Many patients affected therefore request corrective surgery. The list of surgical techniques is long and the most frequently-used solutions are well-known.

[Nursing care in situations of facial image alteration]. / O cuidado de enfermagem em situações de alteração da imagem facial.

This research studies how patients, nursing undergraduate students, and professors perceive the care of patients with facial image alterations, and the implications of this care to the education process. It followed an exploratory qualitative approach, and it was carried out in an university hospital in Santa Maria, Rio Grande do Sul, Brazil, between July 2008 and April 2009. Six patients with facial image alteration, seven nursing undergraduate students and five professors participated. Semistructured interviews and a focal group were used. The data were organized and submitted to the content analysis technique. Two categories were found: meaning of the altered facial image, and nursing education and care. The care to these patients is perceived as a complex, hard and striking experience, that constitutes a unique opportunity for the development of skills necessary to the nurse's education. It was observed the need to insert themes during education that address issues relevant to the needs of undergraduates, and enable them to reflect on their training experiences.