Narbentherapie - EN 31.08.16 14:45 Seite 1
SCAR THERAPY
and what you should know about it
Juzo®. Freedom in Motion
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We wish to thank the following persons for their
editorial support:
Dr. med. Bernd Hartmann
Chief Physician
Centre for Severe Burns with Plastic Surgery
Accident and Emergency Hospital Berlin
Warener Strasse 7
12683 Berlin
Germany
Dr. med. Ingo Jester
Peadiatric Surgeon
Department of Paediatric Surgery
University Hospital of Mannheim
Theodor-Kutzer-Ufer 1-3
68169 Mannheim
Germany
Christian Hartz
Master Orthopedic Technician
Managing Director of EPROTEC GmbH
Warener Strasse 7
12683 Berlin
Germany
We also thank Mr. Guido Sinram from „Das Gesundheitshaus
Fuchs + Möller“, Mannheim (Germany) for providing the images
on page 16.
All rights, in particular the right to reproduce or translate this publication into
foreign languages, is reserved. No part of this publication may be reproduced in
any form without the written permission of Julius Zorn GmbH.
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DEAR READER,
there is often a great deal of uncertainty, both for patients and their
relatives, surrounding the area of scar therapy. This makes it more
difficult for the correct use of compression garments.
The aim of this brochure is to help affected persons to understand just
how important compression therapy is for scar healing. It explains the
effects of compression therapy, and provides practical tips on the use
of Juzo Compression Garments.
We also present effective ways of caring for scars in order to
optimally support the healing of the skin.
Julius Zorn GmbH
Juliusplatz 1
86551 Aichach
Germany
[email protected]
www.juzo.com
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CONTENT
P. 6
THE SKIN
Structure and layers of the skin
P. 8
BURNS AND SCALDS
Frequency of burns and scalds
Deep burns and scalds
Formation of scars
Glossary
P. 13
SCAR TREATMENT AND COMPRESSION
GARMENTS
P. 14
THE SCAR THERAPY PROCESS
Compression right from the beginning
P. 25
Juzo® EXPERT PRODUCT RANGE
Variety of fabrics
Example garments
P. 31
SCAR TREATMENT
Useful tips
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The skin has a lot of essential functions
THE SKIN
The largest organ in the human body
The skin (Latin: Cutis), measuring approx. two square metres in size, is
the largest and most nerve-rich organ in the human body. Its thickness
and structure can vary greatly depending on the particular body region.
The entire organism relies on the skin functioning correctly, and it
performs a number of tasks that are essential to humans, for example
regulating heat, providing a barrier to infection, and protecting against
dehydration. The skin, as a sensory organ and as a means of expressing
feelings, also fulfills important interpersonal functions.
Structure and layers of the skin
Our skin is a tissue with a complex structure. It comprises three layers
that are connected to one another:
• Epidermis
• Dermis
• Subcutis
Sebaceous glands, hairs and nails constitute special forms of skin cells.
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Epidermis: the protective and immunological organ
The epidermis, as the top layer of skin, protects the organism from
mechanical, physical and chemical influences and prevents the entry of
microorganisms into the body. The cells of the epidermis are continuously replenished from the bottom-most cell layer. At the end of their lifecycle, they detach themselves as platelets from the surface of the skin.
Dermis: the network and transport system
Below the thin epidermis lies the more robust dermis which is very
supple. Its elasticity and tear-strength comes from a network of collagen
and elastin fibres. Embedded within it is a widely branched network of
blood and lymph vessels. This circulatory system regulates, amongst
other things, the temperature at the skin. The dermis also contains thousands of nerve fibres. These provide us with a sense of touch, pressure,
pain, temperature and even itchiness.
Subcutis
Dermis
Epidermis
Subcutis: the fat-storing, bottom layer
The subcutis comprises mainly fatty tissue, which serves not only as a
protection against the cold and as an energy store, but also as a cushion.
The fat cells are embedded in a loose network of connective tissue,
which is permeated by larger nerve fibres and a second network of blood
vessels. Hair follicles and also the sebaceous and sweat glands, which
produce the protective film for the epidermis.
Classification of the
skin into three layers
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The skin protects the human body from external influences
BURNS AND SCALDS
The skin is the largest organ in the human body in terms of surface area.
It fulfills many important tasks, for example the body regulates its temperature via the skin. The skin also protects the organism against injury
or intrusion by pathogens. Any damage to the skin can therefore have
serious health consequences and, in extreme cases, even be lifethreatening.
Tissue damage can be caused by external influences such as heat,
chemicals or physical injury. Any large-area wound to the skin is
especially dangerous. This applies, in particular, to burns and scalding
as they can often affect large areas of the body and even damage
the very deep layers of the skin.
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Frequency of burns and scalds
In Germany for example, 12,000 people per year, of which about
7,000 are children, suffer severe burn injuries. Up to 1,400 of these
cases need to be treated in the intensive care units of highly specialized centres for burn injuries.
When considered on a per capita basis, the annual rate of minor and
smaller-sized burns of approx. 600 cases per 100,000 citizens is
relatively frequent, whereas severe burns are quite rare at approx.
two to five cases. The most frequent causes of burns are household or
recreational accidents (60 to 75 percent) and work-related accidents
(20 to 30 percent).
Five percent of all injuries in infancy and early childhood involve burns
or scalds. Toddlers in particular are often the victims of severe scalds
as they explore the household and, for example, pull pots with hot
liquids from the stove. That is why most thermic injuries with children
are seen in the area of the head, the hands and the chest. Hot water at
50 °C or higher is already sufficient to damage a child's skin so seriously
that blisters develop. The content of a hot cup of tea is enough to scald
up to 30 percent of the body surface of a toddler.
Deep burns and scalds
The degree of exposure to heat (temperature and duration), the thermal
conductivity of any fabrics being worn, and the type of first aid given will
influence the extent of burning or scalding. The degree of thermal injury
is determined by the size of the burnt or scalded area, and the depth of
the damage.
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Classification of burn severity by depth:
Degree I
Redness and swelling of the skin, e.g. sunburn.
Degree IIa Redness and swelling of the skin, blister formation, pain:
damage to the epidermis, which rises as a thin-walled
blister. Healing occurs within two weeks under conservative therapy.
Degree IIb Paleness and swelling of the skin, blister formation, pain,
damage right down to the deep layers of the skin. Requires
operative treatment.
Degree III
Leather-like skin areas with white, grey or black discolouring, reduced pain due to destruction of the nerve
endings, complete destruction of the epidermis and
dermis (necrosis) and damage to the subcutis. Operative
treatment is essential.
Wounds caused by burns or scalding are classified
into four degrees of depth
Degrees of depth
Degree I
Degree IIa
Degree IIb
Degree III
The different degrees of depth of burns and scalds
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Formation of scars
Wounds resulting from burns or scalding heal according to the same
principles as other skin injuries. First and second degree (IIa) superficial
thermal injuries generally heal within 14 days without scarring. Where
deeper injury to the skin has occurred, this scar-free spontaneous
healing is no longer possible because the regenerative cell layer has
been destroyed.
In the case of deep burns and scalds, the body attempts to slowly
close the skin defect from the edge of the wound inwards. It does so
by forming new tissue, so-called granulation tissue.
Once the wound has closed, “overgrowth” of the wound frequently
sets in after three to four weeks. The fibrous cords of connective tissue
pack together, harden and then shrink, thereby creating a scar. If the
growth of the fibrous connective tissue cells occurs in an uncontrolled
manner, hypertrophic scars or keloids may be formed.
Scars are not just a cosmetic problem – the thickening and hardening
can also lead to restricted movement, malpositioning of the joint and,
in worst cases, to immobility of the entire limb.
Affected persons also frequently suffer from disturbed sensation and
itchiness. The process of scar tissue conversion (scar maturation) may
take up to two years to complete after closure of the wound.
To obtain the most aesthetic scar healing possible with no functional
deficits, it is necessary to apply a uniform pressure to the affected body
areas. This can only be achieved by means of so-called compression
therapy.
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GLOSSARY
Scar
A scar constitutes the healed state of a skin injury. The connective
tissue of the scar will, at first, be red, fairly inelastic and not very
functional. As the scar matures, it is possible for shrinkage and
hardening to occur.
Hypertrophic scar
An excessive production of collagen fibres leads to the irregular
formation of connective tissue extending beyond the original wound
area.
Keloid
A keloid is an uncontrolled, strong connective tissue growth extending
beyond the wound area into healthy skin. The resultant reduction in skin
elasticity can lead to stiffening of joints.
Atrophic scar
Sunken scars created in poorly healing wounds. They result from an
inadequate production of connective tissue fibres.
Scar formation tending towards hypertrophy
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SCAR TREATMENT AND
COMPRESSION GARMENTS
Deep burns and scalds, and their subsequent repair by skin grafting,
are a common cause of scarring. To ensure no proliferative scars
(hypertrophic scars, keloids) are formed, it is essential to apply external
compression as soon as the wound has healed. Compression treatment
involves the application of a therapeutically effective pressure to the
wound area. This prevents an uncontrolled and excessive reorganization
of the connective tissue from occurring. Under this compression, the
fibrous connective tissue cells proliferating within the wound arrange
themselves uniformly, that is, parallel to the wound and skin surface.
Therapeutic pressure in scar therapy
The constant surface pressure exerted by the compression garment
enables the scarred area to heal more quickly. The consistency of the
raised scar begins to change within just a short time, and the scar
tissue becomes softer. The redness of the scar tissue recedes and the
scar thickness and irritating itchiness decreases. Scar shrinkage, and
the resultant joint stiffness, is also reduced. Even long-standing scars
can be reduced by compression therapy.
Flattened scar under a compression fabric
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Compression right from the beginning
THE SCAR THERAPY PROCESS
Compression right from the beginning
1 Expert selection of the compression garment
Once stable wound closure has been achieved, compression therapy
can be commenced. The staff of the medical products supply store will
take precise measurements of the intended wearer. They will also determine, for example, whether pressure pads are required. The compression
garment is then custom-made based on the measured body dimensions
of the wearer. For hygienic reasons and to allow the material to recover,
it is essential to wash the compression garment on a daily basis. The
patient should therefore ideally receive two compression garments.
2 Selection of the compression class
The intended outcome of the therapy can only be achieved through
regular wearing of a compression garment made in the compression
class prescribed by the physician.
Based on our long-standing experience, a constant treatment of compression class 1 is suitable for child patients. For adolescents and adults,
we typically recommend compression class 1 (18-21 mmHg) for for the
upper extremities, and compression class 2 for the lower extremities.
Compression class 1 should generally be used for garments worn at night.
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3 Duration of the compression therapy
Those patients who have suffered from deep second-degree or thirddegree burns, or have hypertrophic scars, will need to wear the compression garment for at least six months. To obtain the most aesthetic scar
healing possible with no functional deficits, the garment must be worn
consistently – day and night. The compression treatment can be interrupted for short periods to allow the compression garment to be
changed, or for body hygiene or scar care purposes.
The overall duration of the compression therapy will depend on a number
of factors:
• the severity of the scars
• the location and extent of the scars
• the healing reaction, which differs for each person
• the therapy acceptance and patience of the patient and
his / her relatives
You should discuss the therapy duration with your treating physician
in the course of your ongoing care. We recommend quarterly follow-up
appointments.
TIP
Wearing the compression garment around the clock, if possible, until
the scar has fully healed has been found to be beneficial for infants too.
Actively encouraging the child to get used to the compression therapy
will have a positive impact on their acceptance.
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4 Treatment results
Clinical experience has confirmed that good long-term results can be
obtained through regular wearing of well-fitting compression garments.
For example, it can reduce by one third the number of subsequently
required scar revision operations, which are particularly burdensome to
children. A correctly fitted compression garment, when worn for a longer
period of time, can improve the outcome of burns or scalding not only
from a cosmetic and aesthetic viewpoint, but also – very importantly –
from a functional viewpoint.
Juzo Expert Compression Garments that have been custom-made to the
patient's measurements offer the best possible therapeutic efficacy and
long-lasting, optimum wearing comfort.
These pictures show scalding in the sternum area: (left) before compression
therapy, (right) after twelve months of compression therapy in conjunction with
a custom-made silicone pressure pad.
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5 Supporting measures
Juzo Compression Garments guarantee best possible outcomes in scar
therapy thanks to their high quality and perfect fit. Besides compression,
it is also beneficial to apply a skin care product to the affected body area
on a regular basis, e.g. during the daily changing of the compression
garment. If the physician has prescribed a scar treatment preparation,
then it should be carefully massaged into the skin at this time. Targeted
and long-term physiotherapy or occupational therapy can, in many cases,
alleviate restricted movement and help improve the outcome of the
compression therapy.
An optimum therapy outcome can be achieved by combining a flatknitted compression garment (e.g. Juzo Expert) with a Juzo ScarPad
Silicone Pad.
TIP
With young patients, it is especially important that parents, siblings,
physicians and therapists all actively encourage the child to accept the
therapy. Without the cooperation of everyone involved, even the best
treatment will not achieve the desired outcomes.
Regular skin care supports healing
outcomes in scar therapy
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Juzo ScarPad Silicone Pads
Juzo ScarPad Silicone Pads are suited for an effective and individual
treatment of scars. The silicone pad softens the skin tissue and reduces
redness of the skin. It protects the sensitive, healing skin and prevents
anything from rubbing directly against it.
Juzo ScarPad is a self-adhesive scar treatment pad and comprised of
100 % medical silicone. This makes it highly flexible and very adaptable.
The surface is especially soft and comfortable to wear. The skin-like
colour covers the scar and enables a discreet treatment.
Early treatment with Juzo ScarPad prevents abnormal scar formation.
First application occurs after the wound has fully closed or, if the wound
was sutured, a few days after the sutures have been removed. The
special-purpose silicone pads can be used not only for recent but also
for older scars, however still active.
The Juzo ScarPad products come in a variety of sizes and styles.
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Individually adaptable:
The silicone pad can be cut to any size or shape. It can also be worn in combination with compression garments.
A scald of severity IIa to IIb
(2 weeks after the accident)
After two weeks of treatment with
Juzo ScarPad
(4 weeks after the accident)
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6 Follow-up compression therapy
Experience and good judgement are essential when checking the compression pressure. The patient's subjective assessment of the wearing
comfort also needs to be taken into consideration. Where inadequacies
in the fit of the garment are recognized, the patient should be re-measured and a new garment supplied. The physician, therapist or staff
member of the medical products supply store involved in the long-term
treatment of the patient should check, on a regular basis, that the
compression garment is being used in a therapeutically correct manner.
This applies in particular to its fit, which can be compromised by improper treatment of the compression garment, natural wear-and-tear, or
through changes in the size or weight of the patient.
The frequency of these checks can be selected on an individual patient
basis. In the case of children still in the growth phase, the fit of the
garment should be checked at least every two to three months.
Compression garments that have been applied too tightly produce an
increase in pressure that can negatively impact on the movement or
breathing of the patient.
TIP
Optimum outcomes in follow-up compression therapy can only be
achieved through close cooperation between the patient, physician,
therapist, medical products supply store and the manufacturer.
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In addition to compression therapy, follow-up therapeutic or surgical
treatments can help achieve optimum aesthetic and functional outcomes
in scar therapy.
7 Therapeutic follow-up treatment
• consistent wearing of the compression garment
(if necessary in conjunction with silicone pads)
• regular skin care
• physiotherapy or occupational therapy
• long-term review of the burned or scalded areas of skin
and the progress of the therapy (right through to adulthood
in the case of children!)
• avoiding direct exposure to the sun
• using orthopaedic training or support splints (if required)
• joining self-help groups
• if necessary: psychological support
8 Surgical follow-up treatment
• early surgical intervention in the case of functionally
impairing scars or lack of load-bearing capacity
• later surgery for aesthetic corrections
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9 Care of the Juzo Compression Garment
The compression garment should be washed daily at 40 °C, either by
hand or in the machine on the gentle or delicate cycle. Before washing
the garment, turn it inside out and close all fasteners. The Juzo Expert
Garment will dry very quickly thanks to the low viscose content. Do not
use any fabric softener.
40
Example garment: thorax with long sleeves
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EFFICIENT COMPRESSION THERAPY
The Juzo® Expert product range
• Optimum wearing comfort thanks to the flat, elastic and visually
discreet seams.
• Patient mobility is guaranteed thanks to the homogeneous,
soft and smooth material.
• A double-layered covering of the compression fibres with textile
yarns ensures a high level of skin compatibility.
• The double-stretch elastic fabric, which is made to the individual
patient's measurements and produced using a flat-knitting
technique, produces a precisely defined compression.
• The compression garment is suitable for everyday wearing thanks
to the use of latex-free, sunfast and ointment proof, durable yet
breathable materials.
• The fine-meshed surface structure of the fabric combined with
optional incorporated fasteners (hook, zipper and velcro) allow easy
slip-on and taking-off.
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VARIETY OF FABRICS
The experts with seam
Fla
t k nitting
Juzo® Expert
Pleasantly soft for tailored treatment
Thanks to its exceptional softness and bi-directional
elasticity, Juzo Expert provides the greatest possible
freedom of movement and is very comfortable to wear.
This special fabric is ideally suited for full-body garments and, thanks to its certified UV protection factor
of 80 (18-32 mmHg, CCL 1-2), is ideal for use in scar
therapy.
Juzo® Expert Silver
Soft fabric with antibacterial effect
Thanks to the knitted-in silver thread, this fabric provides not only compression but also a natural antibacterial effect. This restores the natural balance of
inflamed or irritated skin, thereby reducing itchiness.
Example garments:
Juzo Expert one-legged panyhose
with open toes
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Juzo® EXPERT PRODUCT RANGE
Example garments
Compression glove with
closed fingers
Compression glove with silicone
coating on the palmar surface
Compression sleeve
Compression sleeve and glove
in one piece
Thorax with short sleeves
Thorax in conjunction with compression pantyhose with velcro connection
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Compression stocking with
open toes
Compression stocking with
open toes and silicone border
Compression bermuda pants
Compression pantyhose with
open toes
Compresssion pantyhose with
closed toes and lateral zipper
Silicone coating on the
sole of the foot
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Compression foot-toe-portion with
open toes
Compression foot-toe-portion with
closed toes
Compression neck-chin-garment
Compression headband
Compression stump shrinker with
silicone border
Compression stump shrinker with
hip attachment
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COLOURFUL IRON-ON PATCHES
Juzo® Expert product range
Iron-on patches for children
There are many colourful iron-on patches of the little helper “Julius”
and his friends which can be applied to a compression garment.
You can find all patches on www.juzo.com/iron-on-patches. Go to
www.juliusbyjuzo.com and find out more about Julius and the whole
concept.
“Lollipop”
“Henriette”
“Chair”
“Whale”
“Gottfried“
“Fridolin“
“Ferdinand”
“Seagrassflipper”
“Diving suit”
“Lotte“
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ARION SLIP-ON AND TAKING-OFF AIDS
for Juzo® Compression Garments
Juzo® Arion Slip-on and Taking-off Aids
The Juzo Arion Products make it simple and easy to put on and take
off medical compression garments such as stockings, pantyhose,
or sleeves. Thanks to the very smooth material, putting on and
taking off a compression garment requires very little physical effort.
For further information please see the product folder Juzo Arion
Slip-on and Taking-off Aids.
Juzo Arion Sim-Slide
Leg slip-on and taking-off aid
Juzo Arion Easy-Slide Leg + Easy-Off
Leg slip-on and taking-off aid
Juzo Arion Easy-Slide
Arm slip-on aid
Juzo Arion Magnide
Leg slip-on aid
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SCAR TREATMENT
Useful tips
A compression therapy using Juzo Expert prevents the formation of
excessive, hypertrophic scar tissue and keloids, which would subsequently need to be removed by an operative procedure. As a result of
the pressure exerted by the compression garment, the scar matures more
rapidly, which inhibits itchiness, and the red colouring of the scar fades.
Compression therapy enables scars to heal in an aesthetic manner with
no functional deficits.
Period of wearing
The compression garment should be worn for the period prescribed
by the physician. This is the only way to guarantee an optimal therapy
result. It is often necessary to wear the garment consistently – day and
night. For hygienic reasons and to allow the material to recover, we
recommend changing the compression garment on a daily basis. The
patient should therefore ideally receive two compression garments.
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40
Washing
The compression garment should be washed each day at 40 °C to allow
the material to recover. This restores the exact fit that is essential for
producing the optimum therapeutic pressure. We recommend washing
the garment with a delicate fabric detergent from Juzo. Do not use any
fabric softener.
Body dimensions
The accuracy of fit of the compression garment can decline over time as
your weight or, in the case of children, size changes. If this is the case,
please consult your medical products supplier. He will check the fit of the
garment and either arrange for any necessary alterations, or recommend
that you be fitted with a new garment.
Scar treatment
The scarred skin can be kept supple by massaging it, and applying a
cream to it every day. Keep the affected area of skin clean to avoid
inflammation. Follow the skin care recommendations provided by your
treating physician.
Exposure to sunlight
Avoid direct exposure to sunlight has to be avoided at all times as this
exposure will promote the formation of hypertrophic scars. Juzo guarantees a UV protection factor of 80 for its Expert product range (CCL 1-2).
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Physical exercise
Regular physiotherapy and / or occupational therapy will help prevent
joint misalignment or stiffening of the limbs.
Skin grafts
Scars resulting from skin grafts are also susceptible to growths. To avoid
these growths and to achieve aesthetic scar results without functional
deficits, it is recommended that compression therapy be used in these
cases also.
Open wounds
Compression garments must not be worn if large open wounds are
present. In the case of smaller wounds, your physician may approve the
use of the compression garment if it is worn on top of a bandage or
wound dressing. Experience has shown that these residual skin defects
heal particularly quickly and without complications under compression
pressure.
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Full-body garments
From foot-toe-portions to stockings and thorax segments right through
to face masks, the Expert product range from Juzo offers garments for
virtually all areas of the human body.
Older scars
Compression therapy can also be effectively employed for older, bulging
scars. Under the action of the compression pressure, the scar tissue
softens, the red area around the scar is reduced, and the thickness of
the scar decreases.
Prescription
Your treating physician will prescribe a suitable compression garment
for you, if required. Please consult your specialist for that.
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Juzo Expert Compression Glove, colour Almond with open fingers
and extra option “Smartphone-Finger”
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Julius Zorn GmbH
Juliusplatz 1
86551 Aichach
Germany
[email protected]
www.juzo.com
EN · 14360203/1/1 · 8413 · 09/2016
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