Customizing Silicone in the Treatment of Hypertrophic Scars and Contractures

Joseph S. Pongratz, CPO, FAAOP
Pongratz Orthotics & Prosthetics, Inc
Phoenix · Mesa · Tucson, AZ

Pongratz Orthotics & Prosthetics, Inc. would like to thank you for your consideration and time involved in reviewing non-operative silicone modalities for scar treatment. We would like to clarify the distinction between silicone sheeting and the materials that we bond with silicone compared to compression therapy for custom burn scar treatment.

The silicone sheeting we utilize is a medical grade silicone that is available in many thicknesses, from 0.6mm to 8mm. Different size sheets are available to accommodate variations of size and area of the scars needing treatment. All of the patient care trials and research articles discussed in this paper are studies utilizing an occlusive silicone sheeting material for the treatment of hypertrophic scars and contractures. Pongratz Orthotics & Prosthetics, Inc. specializes in custom forming silicone to each specific area of the body with materials such as plastic, closed-cell foam, fabric, and cloth.

For example:

  • Silicone Sheeting is for scar treatment on an arm, leg, or thoracic section because these regions are flat and usually require a large surface area of treatment. The silicone used on scars in these locations can be held on with pressure tape, loose garments, or ace bandages.
  • When the facial area is involved we use a Silicone Thermoplastic Mask. Silicone sheeting is bonded to a clear thermoplastic for easy conformability to facial features. A negative plaster mold of the patients affected facial area is obtained and is formed into a positive mold. The positive mold is then used to vacuum form the silicone thermoplastic material. Through hundreds of clinical trials we have found this is the most optimal method of treating the disfigured facial areas while preventing complication which may result from compression therapy.
  • The cervical region requires a Silicone Cervical Collar for treatment because of its sensitivity and function. Silicone is bonded to a semi-rigid closed-cell foam material and is heat molded to a positive mold of the patients cervical region. This semi-rigid material allows the patient to maintain range of motion with their movements while silicone is contacting and treating the scarred areas. This closed cell foam material has been used in orthotics & prosthetics for several years and is used for its superb heat molding properties, durability, and semi-rigid properties.
  • Hand scars require Silicone Gloves that are commercially available. Silicone is bonded to a fabric material and is made into gloves that are sized to the patient. These silicone gloves have open finger-tips so that finger-tip prehension is maintain. We have found silicone gloves to be a very practical and effective method of treating hand scars.

Research has proven the effectiveness of silicone on hypertrophic scars, keloids and contractures. Our clinical trials utilizing silicone for the treatment of these conditions confirms that silicone will significantly improve a patient’s hypertrophic scarring, minimize contractures by overcoming capillary pressure, decrease the perioral fibrosis, and minimize the probability of future surgical revision. The trials were performed on patient’s with mature scars (greater than one year old) as well as immature scars (less than one year old). The standard of care management has been to fit custom pressure garments on patients with hypertrophic scars. With over one hundred clinical trials we have found silicone to be more effective for scar treatment than compression therapy for these reasons:

Silicone compared to compression:
  1. Compression:
    Compression treatment of hypertrophic scars has been utilized as the standard of care following thermal injuries for many years. Numerous studies suggest that 30-40mm/Hg of compression is required 23 hours/day for effective treatment. Garments are measured to patients involved areas and the encompassing body and delivered several days or weeks later. However, there are several uncontrollable factors that effect the results of compression treatment: 1) the patient’s body changing from the original measured size causes the compression to change, 2) the garments material loosing its original strength resulting in a loss in compression, 3) the compliance of patient’s wearing the garment. For these reasons it is difficult to determine if compression is maintained on the hypertrophic scar and if treatment is effective.
  2. Silicone:
    Silicone has been used in the treatment of hypertrophic scars dating back to the 1970’s. The material is manufactured from a medical grade mineral oil formed into a sheet and bonded to a rigid material called the matrix. Studies conclude that silicone is effective on scars by merely just touching the skin for a minimal period of twelve hours/day. When silicone is applied to the skin, there is between 1-5mm/Hg of pressure on the skin, a much more tolerable pressure for patients to wear during the day and night.
    How does silicone work?
    Silicone, acting as an occlusive dressing, prevents evaporation of the bodies own oils and secretions resulting in an increase in the hydration, moisterization, and circulation to the fibrosed skin and overabundant collagen cells. As the mass cells are moisturized they begin to break down and are replaced by new, smoother epithelium that grows as softer, flexible skin. Results of burn patient questionnaires has shown that with silicone on their scars they have improved skin elasticity, body range of motion, skin smoothness and texture, and normalizes skin coloration. Silicone healing methods are vastly different from compression therapy, in our trials they have shown to be more effective and tolerable.
  3. Heat:
    In parts of the country where heat is a major consideration, compression garments are sometimes difficult to wear during the summer months because of the intense heat they generate. Patients have commented on how much more effective and tolerable silicone is to wear for 12 hrs/day as compared to compression garments for 23 hrs/day. Silicone is much lighter, cooler and does not require enclosing a full extremity with compression in order to treat the scars.
  4. Patient Compliance:
    On areas of the body such as the maxilla, mandible, temporal, and cervical regions, it is impractical to treat hypertrophic scars with compression because of the sensitivity of the anatomy. On several occasions we have found that patients rarely tolerate 30-40mm/Hg of pressure in these areas and studies confirm temporal mandibular joint (TMJ) complications as a result of excessive compression to the joint. Therefore, patients tend to loosen or not wear a compression mask garment or chin strap for their facial or cervical scars allowing the scars to grow and contract, causing sever disfigurement and maxiofacial function disorders. The results with silicone thermoplastic mask and the silicone cervical collar contacting the skin has been fabulous for non-operatively treating scars on the face and neck. The most significant reasons mentioned in the questionnaires are that these modalities are lighter, cooler, more cosmetic, less cumbersome, more tolerable and ultimately more effective. Pongratz Orthotics & Prosthetics, Inc. has found that the most effective treatment for hypertrophic scars is one that is effective and a patient is compliant with.

Silicone sheeting with compression garments are not used on the face because the changes in facial contours and bony prominences requires custom molded treatment. Also, adhesive tape or a loose garment of some type is needed to keep the silicone sheeting in place causing the problems previously mentioned with compression therapy. Secondly, we do not use the rigid thermoplastic bonded with silicone on the cervical region due to a restriction in range of motion to this area when using rigid materials. Treating the cervical region we use a custom molded semi-rigid closed-cell foam material bonded with silicone and fastened with velcro closure.

Pongratz Orthotics & Prosthetics, Inc. has identified an effective and beneficial treatment for hypertrophic scars, keloids, and contractures that is beyond the past standard of care for this condition. Specialties are invented as a need for these types of modalities are in demand. If you have an interest in these treatments and would like more information regarding our results, please feel free to call us at (602) 222-3032. Thank you for your time and interest.

Sincerely,

Joseph S. Pongratz, CPO, FAAOP
President – Clinical Director