Actualización en el tratamiento y cuidado de las cicatrices / Update on the treatment and care of scars

Las cicatrices producidas por quemadura causan graves secuelas por limitaciones funcionales y estéticas, y llegan a tener importantes consecuencias psicológicas capaces de limitar las relaciones personales y sociales de los que las padecen. En este artículo se hace una revisión de los tipos de cicatrices, los factores que intervienen en su formación, sus características y una actualización de las distintas opciones de prevención y tratamientos de las cicatrices patológicas en el paciente quemado. El texto concluye con una exposición de técnicas de camuflaje de cicatrices mediante maquillaje (AU)

Scars due to burns cause important aesthetic and functional squeal, causing psicologic disorders that can limit personal and social relationships of these patients. In this article we review the type of scars, the factors influencing its function, its characteristics, and we update the different options to prevent and treat pathologic scars in these patients. The text concludes with an exhibition of camouflage techniques of scars through make-up (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.

[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.

Fisiopatología de la Cicatrización / Pathophysiology of healing

El tratamiento de las heridas forma parte de la práctica diaria del personal de enfermería y el conocimiento de la fisiología de la cicatrización, así como de las técnicas modernas de tratamiento, resulta de gran importancia para proporcionar el método más eficaz y rápido de curación. La respuesta de los tejidos vivos a la lesión constituye la base para entender el proceso de la cicatrización. Un restablecimiento de la integridad total o parcial de los tejidos forma parte de una respuesta básica. Una alteración de la barrera de los tejidos provocará una pérdida de la homeostasis generando un estado de hipermetabolismo sistémico. Por tanto, toda herida que causa una discontinuidad del epitelio de revestimiento en el organismo, desencadena una cascada de eventos en un proceso por lograr que la barrera de protección no se desintegre. Estos eventos permitirán la regeneración del tejido que ha sufrido la lesión, formando un tejido cicatrizal que tenga la capacidad de mantener la barrera de protección y sostén de los elementos que preserva. Se define como cicatrización a un proceso natural de reparación de una herida mediante la formación de una cicatriz. Es importante recordar cómo actúan los mecanismos fisiológicos reparadores, es decir, los procesos de la cascada de la cicatrización, ya que es importante tener en cuenta estos mecanismos de reparación para conocer la base de cómo funcionan los tejidos y así poder valorar y diagnosticar las alteraciones que el paciente presente, con el fin de aplicar un tratamiento correcto y adecuado de acuerdo a las necesidades del enfermo (AU)

Treatment of wounds is part of the daily practice of the nursing staff and the knowledge of the physiology of healing, as well as modern treatment techniques are of great importance to provide the most effective and rapid healing method. The response of living tissues to injury constitutes the basis for understanding the process of healing. A reset of the total or partial integrity of tissues is part of a basic response. An alteration of the barrier of tissues can cause a loss of homeostasis generating a State of systemic hipermetabolism. Therefore, any wound caused a discontinuity of epithelium covering the body, triggers a cascade of events in a process to achieve that protection barrier will not disintegrate. These events will allow the regeneration of the tissue that has suffered the injury; forming a scar tissue that has the ability to maintain the barrier protection and support of the elements that it protects. Defined as scarring, to a natural repair process of a wound by forming a scar. It is important to make a reminder of how you act reparative physiological mechanisms i.e. the cascade of healing processes, it is important to take into account these repair mechanisms to know the basis of how tissues work so you can assess and diagnose the alterations to this patient, in order to apply a right and proper treatment according to the needs of the patient (AU)

Nurse-led management of hypertrophic and keloid scars.

Keloid and hypertrophic scars are difficult to treat, and their management requires a structured approach with input from a multidisciplinary team. Typically, patients are treated in busy, general clinics--an environment that is not suitable for these patients, whose treatment can take considerable time and requires emotional support. The development of a dedicated, nurse-led keloid scar clinic covering scar management and skin camouflage is described, the benefits of which have been evaluated. Results to date show that it is cost-effective, that it has reduced the non-attendance rate at the clinic, and that it improves compliance and has led to better resolution of scars in a shorter time than previously.

Prevención y tratamiento de la cicatriz patológica / Prevention and treatment of a pathological scar

En ocasiones la aparición de una cicatriz patológica es una secuela del proceso de cicatrización que puede llevar aparejadas importantes complicaciones físicas y psíquicas para la persona afectada. Su aparición es más frecuente en heridas que han seguido un proceso de cicatrización por segunda intención y con una evolución tórpida. La prevención debe iniciarse desde el principio del tratamiento de la herida y continuarse durante un cierto tiempo después de su cierre inicial. Cuando, a pesar de todo, la cicatriz patológica aparece, existen diversos materiales y técnicas de tratamiento, que presentan diferentes grados de eficacia (AU)

Topical silastic gel sheeting for treating and controlling hypertrophic and keloid scars: case study.

Hypertrophic and keloid scars form in a healed skin wound by the overgrowth of fibrous tissue after injury or surgery. In this case study the treatment and control of hypertrophic and keloid scars in an adult Chinese male with third degree burns is presented, emphasizing the use of topical silastic gel for scar treatment and control.

A focus on the occupational health needs of the non-white worker.

The nurse's understanding of the culture of the non-white workers is necessary if she is to work effectively with them. Her understanding of their language is vital. She must recognize the specific needs of each group. Some of these needs are psychosocial, economical, and physiological. The necessity for honesty, sincerity and humane respect is emphasized as important in successful working relationships with non-white workers. Once mutual respect has been achieved, an understanding of the cultural, physical, and psychological backgrounds of the workers will help the occupational health nurse provide the same high quality nursing care to all.