Practice Guidelines for the Application of Nonsilicone or Silicone Gels and Gel Sheets After Burn Injury

Abstract

The objective of this review was to systematically evaluate available clinical evidence for the application of nonsilicone or silicone gels and gel sheets on hypertrophic scars and keloids after a burn injury so that practice guidelines could be proposed. This review provides evidence based recommendations, specifically for the rehabilitation interventions required for the treatment of aberrant wound healing after burn injury with gels or gel sheets. These guidelines are designed to assist all healthcare providers who are responsible for initiating and supporting scar management interventions prescribed for burn survivors. Summary recommendations were made after the literature, retrieved by systematic review, was critically appraised and the level of evidence determined according to Oxford Centre for Evidence-based Medicine criteria.

A Pilot Prospective Randomized Control Trial Comparing Exercises Using Videogame Therapy to Standard Physical Therapy

“…Perhaps the most common methods used by burn centers to prevent contractures are splints, serial casting, and silicone gel. [2][3][4] These methods are relatively inexpensive and readily available to most burn centers, but are of variable efficacy due to their static nature and inconsistent patient compliance.Commercially available, interactive videogames that use body movements for interaction are used clinically in burn rehabilitation and have been shown to facilitate functional range of motion (ROM) but their efficacy with burn patients has not yet been proven. The purpose of this pilot randomized control study was to prospectively compare planar and functional ROM, compliance, pain, enjoyment, and exertion in pediatric burn patients receiving two types of rehabilitation therapy.…”

“…Perhaps the most common methods used by burn centers to prevent contractures are splints, serial casting, and silicone gel. [2][3][4] These methods are relatively inexpensive and readily available to most burn centers, but are of variable efficacy due to their static nature and inconsistent patient compliance.…”

Biology and Principles of Scar Management and Burn Reconstruction

“…67 Silicone sheeting treatment is reported to soften, increase elasticity, and improve the appearance of HSc, 68 but conflicting results remain in the literature, which may be attributed to patient compliance. 69 The proposed mechanisms of action include increased oxygen delivery to the epidermis and dermis, hydration of the stratum corneum, surface skin temperature, and reduced tissue turgor. 67,69,70 In vitro evidence demonstrates decreased TGF-β2 levels and fibroblast-mediated lattice contraction with silicone treatment.…”

“…69 The proposed mechanisms of action include increased oxygen delivery to the epidermis and dermis, hydration of the stratum corneum, surface skin temperature, and reduced tissue turgor. 67,69,70 In vitro evidence demonstrates decreased TGF-β2 levels and fibroblast-mediated lattice contraction with silicone treatment. 65–67,69,70 Meta-analysis of the benefits of silicone gel sheets suggests further research is required for high-level evidence of their benefit for HSc, despite ongoing encouraging trials.…”

“…67,69,70 In vitro evidence demonstrates decreased TGF-β2 levels and fibroblast-mediated lattice contraction with silicone treatment. 65–67,69,70 Meta-analysis of the benefits of silicone gel sheets suggests further research is required for high-level evidence of their benefit for HSc, despite ongoing encouraging trials. 68–70 …”