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12-12-2011 | Internal medicine | Article

Postoperative scar massage therapy 'unproven and inconsistently applied'


Free abstract

MedWire News: There is only weak evidence to support the use of postoperative scar massage to improve esthetic outcomes, say US scientists who found that regimens vary widely and outcome measures are not standardized or consistently objective.

Following dermatologic surgery, healing may not be perfect, leaving redness, pain, or a scar, despite adequate planning and technique. This may lead to anxiety and depression among patients and, consequently, an unwillingness to undergo further procedures. Scar massage is commonly advised to improve esthetic outcomes.

To examine the efficacy and regimens used in scar massage, a team led by Jeremy Bordeaux, from Case Western Reserve University, in Cleveland, Ohio, searched the PubMed database for relevant articles, focusing on study type, the number of patients, scar type and location, the time to massage therapy onset, treatment protocol and duration, outcomes measured, and the response to treatment.

The inclusion criteria were met by 10 studies, comprising a total of 144 patients who received scar massage therapy. Thirty scars treated with massage therapy were postsurgical, with the remainder resulting from either trauma or burns.

The time to initiation of massage ranged from immediately after suturing to 2 years. Massage protocols also varied widely, from 10 minutes twice a day to 30 minutes twice a week, and the duration of therapy ranged from 1 treatment alone, to 6 months of therapy.

Outcome was assessed using a broad range of measures, including the Patient and Observer Scar Assessment Scale (POSAS), Vancouver Scar Scale (VSS), scar thickness, scar perfusion, color, pain, pruritus, range of motion of underlying joints, mood, anxiety, depression, patient-reported skin status, and subjective clinical appearance.

Overall, 45.7% of patients experienced an improvement with massage on at least one of the following measures: POSAS, VSS, mood, range of motion, pruritus, pain, depression, and anxiety. Interestingly, 90.0% of surgical scars treated with massage had improvements on the POSAS or in appearance.

The researchers write in the journal Dermatologic Surgery: "Despite the paucity of data on the technique and efficacy of scar massage, it is frequently recommended to patients in an effort to improve scar cosmesis."

While noting that massage "should theoretically be effective", they add: "Our results demonstrate the need for well-designed clinical trials that use objective criteria to establish evidence-based recommendations for or against the use of scar massage in healing surgical wounds."

By Liam Davenport

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