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Scar Therapy and Lymphedema
A scar is a natural part of the healing process after surgery, a burn, or an injury that damages the dermis (deep, thick layer of skin). The greater the damage is, the worse the scar will be.
A normally healing scar is known as CICATRIX forms from the healing of the wound. This scar tissue usually flattens and the redness gradually disappears; however, healing does not always occur this neatly.
A KELOID is an abnormally enlarged, raised, and thickened scar. These abnormal scars may fade and flatten slightly with the passage of time; however, they do not go away.
An ADHESION is an internal band of scar tissue that abnormally holds the scar against adjacent structures. Adhesions do not always resolve with the passage of time and they can become worse.
DISRUPTION OF THE LYMPH FLOW
Scars and adhesions disrupt the network of lymph capillaries that lie just under the skin. This disruption hinders lymph drainage and makes the treatment of lymphedema in the affected area more difficult.
When performing manual lymph drainage or simplified lymphatic drainage, scars can interrupt the lymph flow. When there is a scar in the stroke pathway, it is recommended that you stroke around the scar and not through it.
This is recommended because lymph vessels within the scar tissue have been disrupted the transfer of fluid across a scar is usually ineffective. 
TREATMENT OF SURGICAL SCARS
Always check with your therapist before beginning scar massage treatment. Scar tissue usually heals within six weeks after surgery; however, instead of feeling soft and stretchy, a scar may still be red and tight so that it pulls and limits motions. 
There are two different approaches to ease scar tissue.
Gently perform scar massage for five minutes daily. Include all scars that are limiting lymph movement. Stretches use a firm motion but should not cause an uncomfortable pulling or burning sensation. It is important to spend more time on any areas that feel “stuck.”
Do not use lotion when massaging a scar. This causes the fingers to slide away. After draining or stretching a scar, apply lotion or vitamin E cream to the scar.
DRAINING THE SCAR
Place your fingers on top of the scar and make very gentle circular pumping motions on the scar. Gently work your way down the scar and feel the tissue soften. Repeat this sequence once or twice at each session. This draining of the scar should not hurt nor should it make the scar turn red. 
STRETCHING THE SCAR AREA
To stretch the skin next to the scar, place two or three fingers at the beginning of the scar and stretch the skin above the scar in a parallel direction. Then move the fingers a quarter of an inch further along the scar and repeat the stretch of the adjacent tissue. Work your way along the scar. Repeat this pattern stretching the adjacent skin below the scar. 
An alternative method is to follow the same pattern of finger movements using a circular motion instead of straight stretches. Work your way along the scar in a clockwise and counter clockwise fashion.
The scarring processes after radiation can continue as long as six months after the last radiation treatment. Ask your therapist when you can safely begin radiation scar self-massage.
Massage of this affected area should not begin until at least six weeks after the last radiation treatment and when no scabs are noticeable.
Radiated tissues are delicate and the skin can break easily. Take extreme care when massaging this area. Never massage these tissues if this causes pain or increased redness of the tissues. Perform only brief massage sessions at first. As the tissues continue to heal, gradually increase the length of the massage. 
 Lymphedema Caregiver’s Guide by M. K. Kearse, PT, CLT-LANA, E. McMahon PhD, and A. Ehrlich, MA. Lymph Notes 2009, page 91.
 Living Well with Lymphedema by A. Ehrlich, A. Harrewijn PT, CLT-LANA, and E. McMahon PhD. Lymph Notes 2005, pages 159-160.
© LymphNotes.com 2010. This information does not replace the advice of a qualified health care professional.
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