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Intervention Review

Silicon gel sheeting for preventing and treating hypertrophic and keloid scars

  1. Lisa O'Brien1,*,
  2. Abhay Pandit2

Editorial Group: Cochrane Wounds Group

Published Online: 25 JAN 2006

Assessed as up-to-date: 20 NOV 2007

DOI: 10.1002/14651858.CD003826.pub2


How to Cite

O'Brien L, Pandit A. Silicon gel sheeting for preventing and treating hypertrophic and keloid scars. Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD003826. DOI: 10.1002/14651858.CD003826.pub2.

Author Information

  1. 1

    Monash University, Occupational Therapy, Frankston, Victoria, Australia

  2. 2

    National University of Ireland, Galway, Ireland

*Lisa O'Brien, Occupational Therapy, Monash University, PO Box 527, Frankston, Victoria, 3199, Australia. lisa.obrien@med.monash.edu.au.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 25 JAN 2006

SEARCH

This is not the most recent version of the article. View current version (12 SEP 2013)

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Keloid and hypertrophic scars are common and are caused by a proliferation of dermal tissue following skin injury. They cause functional and psychological problems for patients, and their management can be difficult. The use of silicon gel sheeting to prevent and treat hypertrophic scarring is still relatively new, and started in 1981 with treatment of burn scars.

Objectives

To determine the effectiveness of silicon gel sheeting for:
(1) prevention of hypertrophic or keloid scarring in people with newly healed wounds (e.g. post surgery);
(2) treatment of established scarring in people with existing keloid or hypertrophic scars.

Search methods

Trials were identified from searches of the Cochrane Wounds Group Specialised Register (searched November 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2007); MEDLINE (2005 to November 2007); EMBASE ( 2005 to Week 46, 2007); CINAHL (2005 to November 2007) and reference lists of articles and relevant reviews. The major supplier of silicon gel sheeting (Smith and Nephew) was approached for details of unpublished, ongoing and recently published trials.

Selection criteria

Any randomised or quasi-randomised controlled trials, or controlled clinical trials comparing silicon gel sheeting for prevention or treatment of hypertrophic or keloid scars with any other non surgical treatment, no treatment or placebo.

Data collection and analysis

All relevant trials were assessed for methodological quality. Data were extracted independently by both review authors using a standardized form, and the results cross-checked. All trials, meeting the selection criteria were assessed for methodological quality.

Main results

Fifteen trials, involving 615 people, ranging in age from 2 to 81 years, were included in the review. The trials compared adhesive silicon gel sheeting with control; non-silicon gel sheeting; silicon gel plates with added Vitamin E; laser therapy; triamcinolone acetonide injection, and non-adhesive silicon gel sheeting. In the prevention studies, when compared with a no treatment option; whilst silicon gel sheeting reduced the incidence of hypertrophic scarring in people prone to scarring, (RR 0.46, 95% CI 0.21 to 0.98) these studies were highly susceptible to bias. Silicon gel sheeting produced a statistically significant reduction scar thickness (RR -1.99, 95% CI -2.13 to -1.85) and colour amelioration (RR 3.05, 95% CI 1.57 to 5.96) but again these studies were highly susceptible to bias.

Authors' conclusions

Trials evaluating silicon gel sheeting as a treatment for hypertrophic and keloid scarring are of poor quality and highly susceptible to bias. There is weak evidence of a benefit of silicon gel sheeting as a prevention for abnormal scarring in high risk individuals but the poor quality of research means a great deal of uncertainty prevails.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Silicon gel sheeting for preventing the development of hypertrophic and keloid scars and for treating existing scars.

Hypertrophic and keloid scars are types of abnormal and pronounced scarring that can cause psychological and functional problems for people and can be difficult to treat. Hypertrophic scarring is more common in fair skin and tends to follow surgery and burn injuries, whereas keloid scarring is more common in darker skin and occurs after trivial injuries such as insect bites, ear piercing and vaccination. Scars occurring on some sites of the body, such as the lower face, neck and upper arms are more likely to develop abnormally. Silicon gel sheeting is a soft, self-adhesive sheeting designed to be used on intact skin for preventing and treating both new and old hypertrophic and keloid scars. The review considered evidence on whether silicon gel sheeting prevents the development of hypertrophic or keloid scarring in people with newly healed wounds, and whether it is effective in treating established scars. Trials were identified that looked at prevention and treatment strategies. Most studies were of poor quality and It is unclear whether silicon gel sheeting helps prevent scarring or is effective in treating existing hypertrophic and keloid scars.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

矽膠片 (Silicon gel sheeting) 用於預防和治療肥厚性瘢痕 (hypertrophic scar) 和疤痕增長 (Keloid Scar)

疤痕增長和肥厚性瘢痕是常見的,肇因於皮膚受傷後的真皮組織增生。這些會造成病人功能和心理的問題且他們的處理是困難的。以矽膠片預防和治療肥厚性瘢痕仍然是相當新的使用,且開始於1981年用於治療燒傷疤痕。

目標

決定矽膠片的療效:1) 預防病人有新癒合傷口的肥厚性瘢痕和疤痕增長如術後病人); 2) 治療有肥厚性瘢痕和疤痕增長病人已形成的疤痕。

搜尋策略

確認試驗經由資料庫搜尋,包含:the Cochrane Wounds Group Specialised Register (searched September 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2005); MEDLINE (1989 to June 2002); EMBASE (1988 to May 2002); CINAHL (1982 to May 2002) 和參考文獻清單。接洽矽膠片主要供應商 (Smith and Nephew) 以取得未發表,進行中和最近發表的試驗的詳細資料。

選擇標準

任何隨機或半隨機對照試驗,或對照臨床試驗,以沒有治療,安慰劑,其他任何非手術治療,比較矽膠片用於預防和治療肥厚性瘢痕和疤痕增長的療效。

資料收集與分析

評估所有相關試驗的方法學品質。兩位審閱者用標準格式獨立擷取資料,結果經過交互檢查。所有符合納入條件的試驗,都經過方法學品質評估。

主要結論

本回顧納入13個試驗,共計559位2 – 81歲受試者。這些試驗比較黏附性矽膠片、控制組、非矽膠片、添加維生素E的矽膠片、雷射治療、注射triamcinolone acetonide和非黏附矽膠片。相較於沒有治療,於預防的研究,然而矽膠片降低易有疤痕病人的肥厚性瘢痕發生率 (RR 0.46, 95% CI 0.21 to 0.98) 。這些研究容易有偏差。矽膠片顯著改善疤痕的彈性 (RR 8.60, 95% CI 2.55 to 29.02) ,但同樣的這些研究及容易有偏差。

作者結論

評估矽膠片治療肥厚性瘢痕和疤痕增長的試驗,品質不佳且容易偏差。矽膠片作為預防高危險族群疤痕異常的效益顯示薄弱的證據,證明治療的效益,但研究品質不佳意指有極大的不確定性。

翻譯人

本摘要由成功大學附設醫院尹子真翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

矽膠片預防肥厚性瘢痕和疤痕增長,和治療現有疤痕。肥厚性瘢痕和疤痕增長是顯著且異常的疤痕,會引起病人功能和心理的問題,並難以處理。肥厚性瘢痕比較常見於白皙的皮膚,好發於手術後和燒傷傷口。疤痕增長常見於比較深色肌膚和小傷口,如昆蟲咬傷,穿耳洞和疫苗接種。疤痕會出現在身體某些部位,若出現在臉部下緣,頸部和上手臂,則較可能出現異常發生。矽膠片是柔軟自粘薄片設計用於完整皮膚,以預防和治療新舊肥厚性瘢痕和疤痕增長。本考克藍回顧作者希望尋找:關於矽膠片預防新傷口癒合時肥厚性瘢痕和疤痕增長的形成,以及是否有效治療以生成的疤痕。他們以醫學文獻搜尋隨機對照試驗,發現13個試驗,包含559位受試者,其中三個預防性的研究,八項是著重治療試驗,兩項同時觀察預防和治療效果。大部分試驗品質都不佳,目前仍不清楚是否矽膠片有助於預防或治療肥厚性瘢痕和疤痕增長。