Advice after your nerve block for surgery
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What is a scar?
A scar develops as part of the normal wound healing process. Within 2 to 3 days of the skin’s surface being injured, scar tissue fills in the injured area to close the wound. Scar tissue can continue to develop over many months. Scars can take anything up to 18 months- 2 years to mature.
How do scars heal?
The skin is held together by a glue-like substance called fibrin; the edges of the cut and the gaps between the edges come together to form a scar.
Types of scars
- Flat pale scars – these are the most common type of scar
- Hypertrophic – red raised scars that can remain in status for several years whilst maturing
- Keloid – caused by the production of excess scar tissue at the site of the wound; they can increase in size even after it has healed
- Pitted scars (atrophic) – have a sunken appearance, e.g., pock marks / acne scarring
- Contracture scars – usually caused by skin shrinking and tightening, e.g., after a burn. This can reduce function and restrict movement.
- Unstable scars – are larger wounds that heal over creases but may take longer to heal. These scars can be easily injured and reopen.
Factors that affect wound healing
- Smoking – has been proven to delay wound healing due to the absorption of nicotine, which reduces blood flow to the area and therefore supplies less oxygen to the tissues.
- Age – younger people heal more easily than older people, however scars in older people fade more rapidly.
- IIlnesses – such as diabetes, high blood pressure and poor circulation can decrease the body’s ability to heal.
- Nutrition – studies show that the body needs certain minerals like zinc, vitamin C, iron, protein, and adequate calories to aid effective healing.
- Skin quality and blood supply to the area – for example, skin that has already been thinned and stretched increases the risk of raised, wide, or irregular scars.
- Pregnancy – imbalanced hormones may produce more scar tissue
Scar Treatments
Scar massage
Scar tissue may become hard and raised. Massage can help to soften and flatten the scar tissue which improves the appearance of the scar. Scar tissue may stick to the underlying muscles, tendons, blood vessels, nerves and bones which can reduce movement. Massage can prevent this from happening and helps to keep the scar tissue flexible and helps gain movement.
Scars may feel sensitive, tingle or hurt when touched. Regular massage can help to control this and eventually the sensitivity should settle down.
How to massage: Using cream
- Place a small amount of emollient cream on the scar such as E45, Aqueous cream or any non perfumed cream.
- Begin at the end of the scar furthest away and massage towards your body. Use circular and zig zag motions over the entire length of the scar.
- Use firm pressure to move the scar during massage.
- Spend more time on tethered (stuck), raised or sensitive scar areas.
- Continue for 5 minutes or as advised by your therapist.
Precautions
- Do not massage open wounds.
- Stop massage if your scar becomes blistered or re-opens.
Other Treatments
Using dycem
Apply the blue square to the top of your scar. You should not use any cream and make sure your hand is clean and dry before you start.
Use your thumb to hold the blue square in place, grip the skin and massage with lots of pressure to move the skin over the underlying structures and release the scar tissue.
Using scar silicone – Mepiform
Intended Use
Mepiform is intended for the management of hypertrophic and keloid scars. Silicone products have been shown to assist with the management of scars and help to develop a soft, flat scar of normal colour.
Application
- Open the pack and remove the dressing.
- Cut to appropriate size, ensuring that the dressing overlaps the scar by at least 1cm.
- Ensure the area for application is clean and dry.
- Remove the protective film and apply the Mepiform over the scar with the sticky side down against your skin.
Dressing Change and Removal
• Ideally, Mepiform should be worn for 24 hours a day to achieve the best results.
• Remove the dressing once a day to inspect and wash the skin. The dressing can then be reapplied.
• Mepiform should be changed every 3-7 days or when the dressing no longer sticks to the skin.
• Mepiform is waterproof and can be worn whilst bathing and showering.
Using Cica-care Gel Sheets
Cica-Care silicone gel sheets are used to improve the appearance of red, dark, or raised scars by softening, flattening, and fading them. To use them, first ensure the scar and surrounding skin are clean and dry. Cut the sheet to the size of the scar, allowing for a small overlap. Peel off the backing and apply the adhesive side to the scar, without stretching it. For the first two days, wear the sheet for 4 hours, then gradually increase the wear time by 2 hours per day until the recommended duration is reached. Clean the sheet and the scar daily with mild soap and water, rinsing and drying thoroughly.
Scar Cleaning:
Clean the scar and surrounding skin each time you wash the gel sheet.
Replacement:
Replace the Cica-Care sheet when it begins to wear out or if it becomes difficult to clean. This usually occurs every 14-28 days.
Important Considerations
Open Wounds:
Do not use Cica-Care on open wounds.
Skin Irritation:
If you experience any skin irritation, reduce the wear time or consult with a healthcare professional.
Securement:
If the sheet does not adhere well, especially on difficult-to-cover areas, you may need to use a light bandage or tape to secure it in place.
Using Otoform/Elastomer
Elastomer is a putty like impression silicone (silicone elastomer). It can be moulded and
applied to your scar. It is normally recommended for deep hollow scars that need an
Impression, or for curved areas like the hands. All Otoform moulds are individually made
by your therapist. It is specifically moulded to fit your scar.
How do I apply my Otoform silicone elastomer?
- Wash and dry your scar to remove any cream or perfume.
- Apply the Otoform mould over the scar.
- Secure in place with tape, splint, bandage or pressure garment.
- When you take the Otoform mould off you should wash your scar. Then wash the Otoform mould with a mild soapy solution. Let it air dry.
- Keep your Otoform mould in a plastic bag or air tight container when not in use.
When should I wear it and how long for?
You can wear the silicone elastomer when your wound is healed and dry. It should not be used
on open wounds. It can be worn for 24 hours a day but needs to be removed every 12 hours.
This is to check the skin for redness or soreness, and to wash and dry it before replacing.
Contact Details
If you have any concerns, or need to change your Hand Therapy appointment, please contact the Therapy Department on:
Frimley Park Hospital: 0300 613 3396
Heatherwood Hospital: 0300 614 0540 Option 3
Wexham Park Hospital: 0300 614 0540 Option 2
Contact us
If you have any queries relating to this information, please contact the Hand therapy service.
About this information
Service:
Hand therapy
Reference:
UU/041
Approval date:
21 August 2025
Review date:
1 August 2028
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Important note
This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.