Physical Therapy

Deep-dermal defects with associated hypertrophic scarring can result from burns, necrotizing fasciitis, and severe soft tissue trauma. The physiological scar restriction during wound healing becomes increasingly relevant proportional to the affected area. External mechanical influences (activity or immobilization in daily life) can cause pronounced scarring and adhesions. Overloading results in a renewed inflammatory response and thus in further restriction. Adequate mechanical stimuli can have a positive influence on the scar tissue. “Use determines the function”: Even minimal external forces are sufficient to bring about functional alignment (mechanotransduction). To counteract potential overdosage in deep dermal defects, the first and second marked increase in connective tissue resistance (R1 and R2) seem to be relevant clinical clues for the appropriate dosage in the proliferation and remodulation phase. The current state of research does not allow a direct transfer to the clinical treatment of large and hypertrophic scars. However, the continuous clinical implementation of study results regarding the mechanosensitivity of isolated fibroblasts and the constant adaptation of manual techniques nevertheless provided an evidence-based foundation for manual scar therapy. The manual dosages are adapted to the tissue physiology and the respective wound-healing phase. Clinical observations show improved mobility of the affected regions and fewer relapses into the inflammatory phase due to mechanical overload.