Combining silicone plasters and silicone gels is effective for scar treatment
the verdict
INSUFFICIENT LEANING
refutedsupported
the weight of evidence
3 sources for · 0 against
The retrieved literature discusses the individual efficacy of topical silicone gels and silicone gel sheets for scar treatment, but does not provide direct evidence evaluating the combined use of silicone plasters and silicone gels.
Background: Burn injuries are burdensome to the public health system. Hypertrophic scars are the most common undesirable sequelae associated with burn scar contracture, resulting in reduced hand function. This study compared 2 different forms of silicone combined with pressure garment (PG) to determine the efficacy in hypertrophic scar prevention in hand burns. Methods: A systematic review was also performed, including only randomized control trials with silicone materials in burned patients. A prospective intraindividual randomized controlled trial was conducted to compare the efficacy of 3 treatment groups: silicone gel and silicone gel sheet combined with PG versus PG alone. Results: There were no significant differences in all Vancouver Scar Scale parameters. Three of 6 Patient and Observer Scar Assessment Score parameters showed significant differences among the 3 groups ( P < 0.05). Scar stiffness improved at 8- and 12-weeks follow-up in both silicone gel and silicone gel sheet combined with PG; however, there was no significant difference between silicone groups. Scar thickness significantly improved at 2, 4, and 8 weeks in the silicone gel group compared with PG. Scar irregularity significantly improved at 2, 4, 8, 16, and 20 weeks in both silicone combined PG groups compared with PG alone. Conclusions: Silicone gel and silicone gel sheet combined with PG were more effective than PG alone in some aspects of the Patient and Observer Scar Assessment Score. However, there was no significant difference between the silicone gel and silicone gel sheet on the Vancouver Scar Scale.
Scar stiffness improved at 8- and 12-weeks follow-up in both silicone gel and silicone gel sheet combined with PG; however, there was no significant difference between silicone groups. Scar thickness significantly improved at 2, 4, and 8 weeks in the silicone gel group compared with PG. Scar irregularity significantly improved at 2, 4, 8, 16, and 20 weeks in both silicone combined PG groups compared with PG alone. Conclusions: Silicone gel and silicone gel sheet combined with PG were more effective than PG alone in some aspects of the Patient and Observer Scar Assessment Score.
Silicone materials for medical use are divided into 2 types: gel and gel sheet. The efficacies of both types are supported by previous studies 20 , 21 ; however, there has been no prior randomized controlled trial (RCT) comparing the use of both types of silicone in hand burns. According to the inconclusiveness of the gold standard in the treatment of postburn hypertrophic scar, we hypothesize that combined methods would offer a better clinical outcome. We, therefore, measured the quality of scar by Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Score (POSAS) assessment to determine the hypertrophic scar formation process and its effects.
This study aimed to compare 2 different forms of silicone, gel, and gel sheet combined with PG, to determine the efficacy in hypertrophic scar prevention in hand burns. We focus on both the patient and physician views by using the VSS and POSAS. A systematic review and a double-blind RCT were conducted. Our primary objective was to demonstrate the superiority of combined treatments compared with the use of PG only, whereas our secondary objective was to compare the results of our study with those in the existing literature.
The results showed that both study groups were more effective than the control, but no clinical difference between groups (group 1 versus placebo and group 2 versus placebo, P < 0.05) Lars Steinstraesser et al 27 studied 38 patients in Germany, by conducting an RCT within-subject comparative study to compare silicone spray combined with PG versus silicone sheet combined with PG versus PG alone. The results showed that multimodal therapy with silicone and PG failed to prevent hypertrophic scars when compared with PG alone. Li-Tsang et al 28 conducted an RCT in 104 patients in China, with 3 treatment groups: PG, silicone gel sheet, and a combination of PG and silicone gel sheet.
Demographic Data Variable PGT Alone Silicone Gel and PGT Silicone Gel Sheet and PGT P Number of hands 16 16 16 Age (mean ± SD) 26.75 ± 5.26 26.75 ± 5.26 26.75 ± 5.26 1 Sex (male/female) 16/0 16/0 16/0 Healing process STSG 14 (87.5%) 14 (87.5%) 14 (87.5%) 1 Secondary intervention 2 (12.5%) 2 (12.5%) 2 (12.5%) 1 Site of treatment radial:ulnar (hands) N/A 8:8 8:8 1 History of keloid/hypertrophic scar 2 2 2 1 PGT, pressure garment therapy; STSG, split-thickness skin graft. Each parameter of VSS was compared among three groups, that is, control, silicone gel combined with PG, and silicone gel sheet combined with PG.
The scar irregularity showed significant improvement at 2, 4, 8, 16, and 20 weeks in both silicone material combined
B, At treatment Week 20 (silicone gel sheet on radial site, silicone gel on ulnar site). Fig. 9. Case sample 2. A, at the start of treatment (Wk 0) (silicone gel sheet on ulnar site, silicone gel on radial site). B, at treatment Week 20 (silicone gel sheet on ulnar site, silicone gel on radial site). DISCUSSION The latest practice guideline for scar management advocates silicone therapy as a noninvasive first-line prophylactic and treatment option for both hypertrophic scars and keloids.
26 However, most previous studies that compared silicone material and placebo (without PG) showed superior results in silicone arms; therefore, it may be postulated that combining silicone material with PG to the burned hand area does not improve clinical outcomes when evaluated by the VSS. Besides, it cannot be ruled out that the protective effects of PG alone may equal those of silicone alone. Our POSAS assessment showed significantly improved scar quality in terms of stiffness and thickness, up to the 12 weeks follow-up, whereas scar irregularity showed significant improvement up to the 20 weeks follow-up. When compared with previous studies, results are in agreement.
Both silicone gel and quercetin are effective in scar treatment but have different action mechanisms. Quercetin is mainly applied in the gel form and can lead to poor adhesion of silicone gel sheet; therefore, they cannot be combined in clinical use. In this study, a silicone gel sheet that releases quercetin in a sustained manner for 48 hours was successfully developed. Four round scars (Ø: 1 cm) were made in the ears of New-Zealand albino rabbits (n=10). After scar healing, the rabbits were divided into four groups: blank control group with no treatment, silicone gel sheet group with dressing change every 2 days, quercetin group with dressing change 3 times daily, and combination treatment group with dressing change every 2 days. Scar assessment was performed 3 months later. Transepidermal water loss showed no difference between the combination treatment group and the silicone gel sheet group, but was lower than that in the quercetin group and the blank control group. Immunohistochemistry of CD 31 and proliferating cell nuclear antigen showed the following results: combination treatment group < silicone gel sheet group = quercetin group < blank control group. Polymerase chain reaction results showed that the expression of type-I and type-III collagen in the combination treatment group and the quercetin group was significantly lower than that in the other two groups. Thus, quercetin-modified silicone gel sheet combines the advantages of the two treatments and is more effective at inhibiting cell proliferation in scar tissue than either of the two treatments alone.