Background
This young woman sustained a degloving injury to her leg in a road traffic accident in 2020, resulting in extensive skin loss requiring skin grafting. The injury was so serious that there were initially concerns about whether her leg could be saved.
When I first met her, three years after the accident, she had already undergone extensive rehabilitation, including physiotherapy, but had not received specialist hands-on scar management.
Presenting Problem
Despite her previous rehabilitation, she continued to experience severe pain, swelling around her foot and ankle, and an overwhelming sensation of tightness from the scarring.
Clinical Assessment
The scar tissue was exceptionally rigid and adherent, with almost no movement or flexibility.
To describe how it felt during examination, it was rather like pressing against a brick wall – there was simply no give in the tissue.
There was also swelling around the foot and ankle, and movement of both the ankle and toes was severely restricted.
Scar Management
Treatment focused primarily on improving scar mobility and pliability using a combination of manual scar mobilisation and LPG, a mechanical method of mobilising scar tissue.
Treatment was delivered over a series of weekly appointments, with progress assessed through changes in the physical characteristics of the scar and the patient's symptoms.
Outcome
The most noticeable change was the improvement in scar pliability. Tissue that had initially felt exceptionally rigid became noticeably softer and more mobile.
The patient also experienced reduced pain, less tightness and improvement in swelling around her foot and ankle.
What can we learn from this case?
Older scars may still respond to treatment. Scar maturation does not necessarily mean that the tissue can no longer change. Even several years after injury, there may be opportunities to improve scar mobility, comfort and function.
Scar rehabilitation is part of a much bigger picture. Severe traumatic injuries often involve damage to bones, joints, nerves and other tissues. Effective rehabilitation needs to consider all these structures, alongside the psychological and social impact of the injury.
Recovery involves many people and different forms of support. This patient's progress reflected her own determination, support from family and friends, and input from numerous healthcare professionals and organisations, including the Katie Piper Foundation.
Specialist scar management was one part of that wider rehabilitation journey, addressing problems that had persisted despite considerable previous treatment.