Use of tape for the management of hypertrophic scar development: A comprehensive review

Abstract

Introduction: Tapes have been used to aid fresh wound closure. For hypertrophic scars, the use of tapes as a therapy to reduce the mechanical forces that stimulate excessive and long-term scarring is yet to be evaluated. The aim of this comprehensive review was to explore the current clinical application of tapes, as a minimally invasive option, as purposed specifically for the management of hypertrophic scarring, regardless of scar causation. Method: Databases were searched using MeSH terms including one identifier for hypertrophic scar and one for the intervention of taping. Studies included the following: patients who received tape for a minimum of 12 weeks as a method of wound closure specifically for the purpose of scar prevention; those who received tape as a method of scar management after scar formation; reported outcomes addressing subjective and/or objective scar appearance; and were available in English. Results: With respect to non-stretch tapes, their use for the prevention of linear surgical scarring is evident in reducing scar characteristics of height, colour and itch. Statistically significant results were found in median scar width, reduction in procedure times and overall scar rating. Tapes were predominately applied by participants themselves, and incidence of irritation was infrequently reported. After 12 months, significance with respect to scar pain, itch, thickness and overall scar elevation was reported in one study investigating paper tape. Two papers reported the use of high stretch tapes; however, subjective results limited formal analysis. Although the use of taping for abnormal hypertrophic scar management is in its infancy, emerging research indicates tapes with an element of stretch may have a positive impact. Conclusions: Non-stretch tapes, for the prevention of linear surgical scarring, are effective in reducing scar characteristics of height, colour and itch. Paper tapes have shown effectiveness when applied during wound remodelling or even on mature scarring, with reported subjective changes in scar colour, thickness and pliability. Preliminary evidence of the benefits of high-stretch, elasticised tapes for scar management in the remodelling phase of wound healing have also been reported. Lay Summary Patients are often concerned about unsightly scars that form on their bodies after trauma, especially burn injuries. These scars can be thick, red and raised on the skin, and can impact on the patient’s quality of life. For some scars, the process of skin thickening continues for up to two years after an injury. Unfortunately, scar formation is a part of the body’s healing process, whereby there is a constant pull or tension under and along the skin’s surface. The use of simple tapes, such as microporetm, to help with wound closure are sometimes used as a therapy to reduce the tension on the skin’s surface when a wound is healing to minimise scar formation. However, the effectiveness of taping has not been proven. This paper looks at the available evidence to support the use of taping to reduce scar features of height, thickness and colour. Initial evidence of mixed levels, suggests some benefits of tapes for scar management and show preliminary efficacy for reduction of scar height, thickness and colour. More research is required to determine the direct impact, comparison to other treatments available and patient viewpoint for this therapy.

Down-Regulating Scar Formation by Microneedles Directly via a Mechanical Communication Pathway

“…It is mainly used to prevent scar formation by reducing tension around the linear incision. 67 But, in our study, rather than targeting the tension around a scar, we aimed to demonstrate that SF MN-induced physical intervention tends to reduce the mechanical communication in the ECM of scar tissue, thereby reconstituting a low-stress microenvironment that can benefit HS reversion. In addition to being applicable to linear surgical scars, the MN patch also shows better adaption on wide patchy scars than tension-reducing tapes.…”

“…However, these existing long-term scar administrations still heavily depend on clinicians and their skills and are expensive. , Besides, the commercial tension-reducing tape is clinically used for linear scars, especially for scars after surgical incisions. It is mainly used to prevent scar formation by reducing tension around the linear incision . But, in our study, rather than targeting the tension around a scar, we aimed to demonstrate that SF MN-induced physical intervention tends to reduce the mechanical communication in the ECM of scar tissue, thereby reconstituting a low-stress microenvironment that can benefit HS reversion.…”

Mechanomodulation: Physical Treatment Modalities Employ Mechanotransduction to Improve Scarring

“…Multi-directional or cyclical tension on a scar will result in a hypertrophic scar [73,74]. Clinical experience has shown us that the most reliable way to support a scar is using tape, and initial evidence of mixed levels suggests some benefits of tapes for the management of hypertrophic scars and keloids [75,76]. Reiffel et al [77] suggested longitudinal taping in the direction of the scar rather than at right angles to it.…”

Surgical considerations in skin of colour: minimizing pathological scars

“… a Not all patients will need every treatment modality mentioned above; however, most patients at high risk will require some of the treatment modalities mentioned in the 0‐week to 1‐month sections initiated in that time span to prevent or significantly minimize hypertrophic or keloid scarring. Intralesional agents and/or radiotherapy are usually required once a keloid scar starts forming in these high‐risk groups 24–30 …”

“…Timely removal of sutures (as early as the wound is able to hold itself together) and good wound care is essential, as well as staged serial postoperative photography to monitor progress. Table 1 [25][26][27][28][29][30][31] summarizes the approximate times that different high-efficacy postoperative treatment/management can be commenced to prevent or minimize pathological scarring. A number of these novel therapies, such as BoNT-A and verapamil, are offlabel uses and will require the appropriate patient information and consent.…”