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Hypertrophic scarring is a difficult problem for burn patients (Image 7), and scar an essential aspect of outpatient burn therapy.

Perhaps the most virulent hypertrophic scarring is seen in deep dermal burns th spontaneously in 3 or more weeks; this seems especially true in areas of highly e the lower face, submental triangle, anterior chest and neck).

The wound hyperemia seen universally following burn wound healing should beg about 9 weeks after epithelialization. In wounds destined to become hypertrophi neovascularization occurs with increasing (rather than decreasing) erythema aft

Available tools to modify the progression of hypertrophic scar formation are limi and effectiveness. These tools include scar massage, compression garments, top steroid injections, and surgery. In some contractures over major joints, serial cas useful.

Conscientious scar massage can be effective in limited areas of scarring, a convenient since it can be performed by family members. Ideally, this tech performed several times each day. Bland moisturizers, which minimize dry healed burns and skin grafts, are applied . Evolving hypertrophic areas the in a firm and slow manner.

Despite the controversy over its use, compression garments seem to impro broad areas of hypertrophic scarring, particularly in young children in whom seems to be more severe.

Compression garments should be worn 23 hours a day until wound er to abate, usually about 12-18 months after injury.

In growing and young children, frequent refitting and replacement of garments are required. Garment fit must be verified after manufactur fitting garment is less effective and can be uncomfortable.

Topical silicone, applied to the healed wound as a sheet, is effective when areas of a troublesome hypertrophic scar.
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Having the silicone in place 24 hours a day is ideal, except during bat

Some children develop a rash beneath the topical silicone, but this ra resolves with removal of the silicone; in these patients, 12-hour or ev application seems to help. Silicone sheets can be placed beneath compression garments or can by one of several elastic devices.

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Firm pressure is not required for the silicone to be effective.

For only localized and very symptomatic areas of early hypertrophic scars, they are in highly cosmetic locations or are causing extreme pruritus, direc injections can be useful .
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Limit the total dose so that systemic effects do not occur.

These injections are painful, as they require high pressure to infiltrate hypertrophic scars; in children, general anesthesia usually is required

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Only localized and very symptomatic areas are treated in this fashion Extreme pruritus is a frequent part of burn wound healing.

Pruritus typically begins shortly after the wound has healed, pea 4-6 months after injury, and then gradually subsides in most pa especially troubling at night.

In most patients, it is adequately treated with massage, moistur antihistamines at night. Alternative approaches are available, a works reliably for everyone.

In patients particularly troubled by pruritus, a sequential therap each maneuver often identifies one particularly helpful method: containing vitamin E, topical antihistamine creams, topical cold frequent application of moisturizing creams, or colloidal baths.

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Localized highly pruritic scars often respond to a steroid injectio

In rare cases, pruritus becomes so intense that excoriations dev

These wounds can become superinfected with Staphylococcus a further exacerbates the pruritus.

To allow healing of excoriated areas, some patients require adm care and antibiotics to control the pruritus and infection.

Burn wound pruritus is a difficult but usually self-limited problem an effective solution.

Surgical excision or incision and autografting are useful maneuvers when o management tools are ineffective.