Hand Scar treatment

Following suture removal, it is normal for the wound margins to separate slightly later in the day following suture removal. The wound may appear to be opening, and that the depths of the wound may be 2 mm deep or so, with pink flesh at the base. This is due to the presence of callus on the skin of the hand and does not represent a problem.

Wound strength is adequate to prevent the wound from opening further. The skin of the palm will peel during the course of the week following suture removal. It is normal for the palm to be most tender and most sensitive to the touch during the interval of time from two to six weeks following surgery.

Scar maturation

Scar tissue begins to shrink seven to ten days following surgery, affecting all of the moving parts, and drawing them together. You will often have more stiffness at two weeks than one week after surgery. This is all the more reason to start exercises early.

The effects of scar tissue shrinking and maturing result in adhesions which pull on nerves and other structures. This often result in brief shooting or electrical pains with motion, particularly when you stretch the hand out to reach an item at arm's length. Sudden shooting or electrical shock pains may also occur spontaneously while you are doing nothing. Both of these are normal occurrences and improve with time.

Shrinking and swelling associated with scar maturation results in the feeling of a lump at the surgical site.

Range of motion exercises

At your clinic visit you will be instructed on active range of motion exercises. This will involve aiming to place the palm flat on a tabletop with all fingers touching the table along their length, and full composite flexion in which the fingertips are wound up into the palm. You may be instructed to use the thumb of the opposite hand to apply to the nail of the scarred hand to encourage flexion. The aim is to flex the fingers to the point of discomfort and just a little more. Hold this position for a count of 10 and then relax.  Repeat this for each stiff finger. The aim is to stretch the stiff tissues and allow the collagen to glide again. Exerting too much pressure will tear the soft tissue and extend the period of rehabilitation. Stiffness is the most common problem following surgery, and that at least three repetitions of these exercises should be done at least three times every day. The fingers may be limbered up with exercise, but the normal swelling following surgery results in stiffness returning within minutes after exercises have been stopped.  Once the exercises have commenced morning stiffness may get worse. This tendency will improve gradually over a period of months. Some days will be harder than others.

Swelling and pain

All hands swell after injury or surgery. Swelling is an accumulation of extra body fluid, and causes many problems even if it is not visible. Most of the pain and stiffness which follows injury or surgery is due to pressure in the wound from swelling. The best treatment is to reduce this pressure by elevating the hand higher than the heart. For at least three days after surgery - day and night (two or three pillows can be used at night). Swelling may also be aggravated by tight splint straps or bandages and these should be placed loosely on the forearm.

Smoking

Smoking interferes with wound healing, and increases the chances that skin and bone will not heal properly. It also tends to make wounds more painful, and blocks the action of some pain medications. Smoking may directly aggravate many hand problems, and should be avoided. It has been shown that the cutaneous circulation drops to 20 percent of normal for between one and four hours after one puff of a cigarette, and during this time healing will stop and bacteria are given a free hand.

Infection

Infection should be suspected if there is redness, pain or swelling that gets worse over the course of the day or night, despite elevating the hand. Infection is uncommon less than four days after surgery or more than two weeks after surgery.

Instructions for desensitisation

To make your hand less tender

Hand injuries are often very tender during the early healing phase. Often tenderness in scars gets worse starting one to two weeks after injury or surgery. Unfortunately this tenderness does not always go away by itself.

The nerves in the hand are special and are more sensitive than other parts of the body. After any injury, the skin of the hand must get used to being touched again for the tenderness to go away. If you do not touch the sore areas of your hand, they may remain very sensitive and tender and this may get worse instead of better. The nerve fibres require stimulation to know that they have recovered. If they do not get this they try harder. For the patient this means the tenderness gets worse and worse.

The techniques of PERCUSSION and FRICTION MASSAGE outlined in this pamphlet will help speed up the process of recovery from tenderness in your hands and fingers.

The goal of these exercises is to make your wounds less tender. It is normal for these exercises to be somewhat uncomfortable while doing them or shortly afterwards. If the exercises are too painful, try using less pressure. If that does not work, then give yourself a two hour break and try again. If pain again is a problem, speak with your doctor or your therapist. These exercises will not be recommended until it is safe to do them.

Percussion (tapping)

This technique activates the automatic reflex which makes us ignore things which are very repetitive. This reflex will dull the tenderness in areas of your hand that are touched repeatedly.

Tap lightly on the area of your hand which is tender. You can tap on the sensitive area with a finger tip of your other hand or with a light object such as a pencil. Find the spot which is the most tender.

Note the time, and begin to tap rapidly (2-3 times a second), lightly and continuously on the most tender area.

Keep tapping without a break for three minutes or until you notice the feeling in the area change. The area may start to feel numb or it may simply feel a little bit less tender.  Take a minute rest and begin again. You may find that a different area is now the most tender spot.

This exercise should be done as many times as possible during the day. It takes many thousands of taps to really change the tenderness in a sore area. The sooner you accumulate that many taps, the sooner your wounds will be more comfortable.

Friction massage

The goal of friction massage is to STRETCH the scar tissue beneath the skin. As with percussion, it should be done many times during the day. This exercise not only helps improve tenderness, but helps restore the contour of the skin to a more normal appearance.

Place a finger tip of your other hand against the central area of the scar.  Mentally note four directions that the skin can be pushed sideways: near, far, left and right.

With your finger tip pressed firmly against the scar and without sliding, gently but steadily push the skin to one side as if you were trying to slide the skin off of the bone. Hold this position for five seconds.

Briefly relax and then repeat this manoeuvre in one of the other directions. Make sure you attempt to slide the skin in all four directions.

If the scar is wider than your finger tip, repeat this stretching exercise on every point of the scar.

This exercise is done without any skin lubrication. After this exercise apply a little simple moisturizing cream.