Early Compression Therapy for Deep Skin Defects: A New Treatment Option to Prevent Hypertrophic Scars or Contractures

Abstract

Background: Conservative treatment of deep dermal or full-thickness skin defects often results in hypertrophic scars or contractures; thus, compressive therapy has been used after wound closure to prevent or treat scar deformities. However, wound contraction begins in the early proliferative phase and peaks after 2 weeks. We therefore attempted early compression therapy as a means of conservative treatment of deep-skin defects and evaluated its clinical outcomes. Methods: In 21 cases of deep skin defects (19 patients), early compressive therapy was started the second week after injury. Saline-moistened gauze or foam dressings were placed on open wounds, and foam dressings or silastic plates were used after epithelialization. The compression materials included elastic bandages, adhesive tapes, or garments. The final scars were assessed using the Vancouver Scar Scale (VSS) and satisfaction degree.Results: Defect size ranged from 1.4×0.7 to 5×5 cm. The duration of compression was 4 to 12 months. The follow-up periods were 4 to 61 months. Mild scar hypertrophy or contracture occurred in 15 cases and subsided after application of topical corticosteroid or triamcinolone injection. The final scar shapes were linear (n=12), geographic (n=5), and oval (n=4). The mean VSS score was 2.3. The degrees of satisfaction were excellent (61.9%) and good (23.8%). In most cases, aesthetically and functionally satisfactory outcomes without pathologic scars were demonstrated with minimal scar size, high scar quality, and high satisfaction.Conclusion: Early compression therapy might be a good option to prevent pathologic scars in the conservative treatment of deep skin defects.