<h4>Background</h4>Scar massage is used in burn units globally to improve functional and cosmetic outcomes of hypertrophic scarring following a burn, however, the evidence to support this therapy is unknown.<h4>Objective</h4>To review the literature and assess the efficacy of scar massage in hypertrophic burn scars.<h4>Methods</h4>MEDLINE, PubMed, Embase, CINAHL and the Cochrane Library were searched using the key words "burn", "burn injury", "thermal injury" and "scar", "hypertrophic scar" and "massage", "manipulation", "soft tissue mobilisation", "soft tissue manipulation". The articles were scored by the assessors using the Physiotherapy Evidence Database (PEDro) scale and outcome measures on range of motion (ROM), cosmesis (vascularity, pliability, height), pain scores, pruritus, and psychological measures of depression and anxiety were extracted.<h4>Results</h4>Eight publications were included in the review with 258 human participants and 15 animal subjects who received scar massage following a thermal injury resulting in hypertrophic scarring. Outcome measures that demonstrated that scar massage was effective included scar thickness as measured with ultrasonography (p=0.001; g=-0.512); depression (Centre for Epidemiologic Studies - Depression [CES-D]) (p=0.031; g=-0.555); pain as measured with Visual Analogue Scale (VAS) (p=0.000; g=-1.133) and scar characteristics including vascularity (p=0.000; g=-1.837), pliability (p=0.000; g=-1.270) and scar height (p=0.000; g=-2.054). Outcome measures that trended towards significance included a decrease in pruritus (p=0.095; g=-1.157).<h4>Conclusions</h4>It appears that there is preliminary evidence to suggest that scar massage may be effective to decrease scar height, vascularity, pliability, pain, pruritus and depression in hypertrophic burns scaring. This review reflects the poor quality of evidence and lack of consistent and valid scar assessment tools. Controlled, clinical trials are needed to develop evidence-based guidelines for scar massage in hypertrophic burns scarring.

Abstract Aims and objectives This study explored the physical and psychological effects of scar massage on burn patients. Background Hypertrophic scar development is highly prevalent following burn injuries. Scar massage may have physical and psychological effects, although evidence of its effectiveness for burn scar improvement remains inconsistent. Design A systematic review and meta‐analysis of randomised controlled trials and quasi‐experimental trials. Methods This study was conducted following the Centre of Reviews and Dissemination guidelines and the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement. Cochrane Library, Web of Science, Cumulative Index to Nursing and Allied Health Literature, PubMed, EMBASE, and Chinese Electronic Periodical Services were searched for studies published between January 1990 and February 2022. Quality was assessed using the Joanna Briggs Institute (JBI) Appraisal Checklist. The final recommendation strength was assessed according to the JBI recommendation rating. A meta‐analysis was performed using Review Manager Version 5.4 software with a random‐effect model. Results Seven studies (420 participants) investigating scar massage for burn patients were included. The scar massage sessions lasted 5–30 min and were delivered by massage therapists 1–3 times a week for 12 weeks. Overall, scar massage decreased pain levels (standardised mean difference [SMD]: −2.39; 95% confidence interval [CI]: −3.96 to −0.83), improved scar thickness (mean difference: ‐0.05; 95% CI: −0.1 to −0.0), reduced pruritus (SMD: ‐1.89; 95% CI: −2.95 to −0.82) and reduced anxiety (SMD: ‐1.52; 95% CI: −2.73 to −0.32), but no significant effect on depression(SMD: ‐0.92; 95% CI:‐2.28 to 0.44). Conclusions The meta‐effects of scar massage among burn patients are significantly improved scar formation and reduced pruritus and anxiety. Providing scar massage is feasible and effective for burn patients. Future research should evaluate its long‐term effects. Relevance to clinical practice Scar massage is relatively convenient and effective in preventing and alleviating hypertrophic burn scarring. Further research can provide detailed suggestions for effective scar massage implementation.

Abstract Despite advancements in burn care, evidence estimates that pathological scarring occurs in 32%–75% of cutaneous burns. Scar massage therapy is an under researched method of management for hypertrophic burn scars which has scope to be a low-cost treatment alternative. The aim of this systematic review was to determine the efficacy of scar massage techniques for common hypertrophic burn scar symptoms such as contraction, pruritus, pain and visibility. The keywords and corresponding MeSH terms were inputed into PubMed, EMBASE, Cochrane database of Systematic Reviews, University Library of Hull, York and Queen Mary, University of London. Following the implementation of predetermined inclusion and exclusion criteria, ten papers were included for data extraction. Quality assessment of all papers was performed using the Cochrane Risk of Bias tool and ROBINS-I tool. Data pertaining to the nature of the participant demographics, scar massage treatment, and study outcomes was extracted. Nine of the ten studies showed a significant improvement for scar massage treatment of hypertrophic burn scar symptoms despite using different massage techniques. Friction and oscillation massage was used in partnership to improve scar function, whereas effleurage and petrissage used in longer sessions was seen to improve scar visibility and pain. Scar pruritus was improved by each massage technique. Scar massage has been shown to be effective at improving scar outcomes. This paper suggests massage techniques should be tailored to the patients’ symptoms. A large, randomized control trial is required to advance this area of research.

Review question/objective The objective of this review is to identify and synthesize the best available evidence on the effectiveness of moisturizer use for the management of burn scars following severe burn injury. More specifically, the review will focus on the following question(s): What are the recommended types of moisturizers used on scar formation in patients who have sustained a burn injury? What is the effectiveness of moisturizer use on scar outcomes, including formation, breakdown, patient acceptance and water loss, following severe burn injury? Background The common mantra that patients often leave a burns unit with is "moisturize and massage". The modality of scar massage is well-recognized as an important part of burn scar management.1 Following the maturation of scar tissue after a burn injury, massage is commenced as part of the standard care offered to victims of burn injury. The premise behind massage is that it maintains joint mobility, aids softening and remodelling of scar tissue and improves scar elasticity through loosening adhering fibrous tissue, whilst also assisting with pruritus, a common side effect of healing following burn injury.1 When healing skin has gained sufficient strength to tolerate massage with the use of friction, scar massage is routinely performed with the use of lubricants,1 which commonly consist of skin moisturizers. Although existing literature provides guidance on the use of products that are fragrance free and free from other skin irritants,1 little is known in regards to recommendations on the ideal composition of moisturizers for optimal scar management. Products used should not have a negative effect on skin/scar integrity, such as breakdown of the skin. Various products have been reported for use in practice as well as in literature on scar management, include aqueous cream BP, bees wax and herbal oil creams,2 silicone based creams and paraffin/petroleum based products. Aqueous cream BP is a readily available and relatively cheap emollient that is fragrance and color free. Its formulation consists of purified water, white soft paraffin, cetearyl alcohol and sodium lauryl sulfate (SLS), liquid paraffin, and phenoxyethanol. Previously reported as the "standard treatment" for moisturization and massage in some burns units,2 aqueous Cream BP contains SLS, which has been documented as a known skin irritant.3-6 The application of aqueous cream BP in subjects with healthy skin, following the removal of increasing amounts of their stratum corneum, has also been shown to increase transepidermal water loss (TEWL) and disrupt the normal skin maturation process.7 Chronic application of aqueous cream BP was also shown in this study to increase the rate of skin turnover as well as contribute to thinning of the stratum corneum.7 This is of particular concern in burn injury as scar tissue has been shown to have increased TEWL when compared with healthy skin,8. In contrast, a comparison study between aqueous cream BP and bees wax and herbal oil cream indicated that newly healed skin in the bees wax and herbal oil group "appeared supple and moist" when compared to the aqueous BP group. Healing skin in the latter group was reported as appearing dry in contrast.2 Although the study had a small sample size, it did demonstrate that bees wax and herbal oil cream provided a greater reduction in the symptom of itch following burn injury along with a decreased use of antipruritic medications when compared to aqueous cream BP.2 The aim of this study was to compare the effectiveness of both preparations in the management of post burn itch. Anecdotal reports of alternate formulations, including silicone and petroleum based products (such as Vaseline), being used by burns units around the world are often reported at burns symposiums and forums, with their selection appearing to be based on historical practice, clinician preference, patient tolerance or beliefs in herbal medicine. Pressure garment manufa

Background and aim Post-burn scarring is a prevalent condition, and the existing non-surgical treatments exhibit varying degrees of efficacy. There is limited evidence available to determine the effective non-surgical treatment for post-burn scars. This study employs a multi-index network meta-analysis to conduct a comprehensive evaluation and comparative ranking of non-surgical treatments for post-burn scars. The aim is to identify the most effective treatment methods, thereby providing a robust, evidence-based foundation to guide clinical decision-making. Methods PubMed, Web of Science, Cochrane Library, PEDro, and Embase were systematically searched for eligible randomized controlled trial studies, and the network meta-analysis was performed via a frequentist approach. The primary outcomes assessed were Vancouver Scar Scale score, scar thickness and Visual Analogue Scale score. Results A total of 17 studies and 1,013 participants were included in this analysis. The treatment ranking revealed that massage therapy demonstrated the most significant efficacy in reducing Vancouver Scar Scale score (surface under the cumulative ranking curve [SUCRA] = 89.0%), CO 2 laser therapy exhibited the highest efficacy in decreasing scar thickness (SUCRA = 96.8%), and extracorporeal shock wave therapy + routine treatment showed the most significant efficacy in reducing Visual Analogue Scale score (SUCRA = 58.6%). Conclusion This network meta-analysis illustrates that massage therapy, CO 2 laser therapy and extracorporeal shock wave therapy + routine treatment are the most effective non-surgical treatments for reducing Vancouver Scar Scale score, scar thickness and Visual Analogue Scale score for post-burn scars, respectively. However, the findings reflect outcomes at a specific stage of scar maturation. And our conclusions must be interpreted with caution due to the limited number of studies included. In the future, well-designed randomized controlled trials with a large sample size are needed to validate these findings.