Dermato-functional physiotherapy addresses the physiology of wound healing and differentiates between scar types in order to ensure the most effective healing process, whether in the immediate or late postoperative phase. The physiotherapist selects appropriate techniques and tools according to each stage of healing to achieve optimal outcomes.
 

Types of Scars:
 

a) Primary intention healing:
Occurs when wound edges are properly approximated and there is no contamination, as seen in most surgical incisions.

b) Secondary intention healing:
Occurs when there is substantial tissue loss, leaving wound edges apart and requiring granulation tissue to fill the gap.

c) Tertiary intention healing (delayed primary closure):
Used in cases where there is insufficient tissue to approximate wound edges, often involving contamination, and generally not suitable for secondary intention due to infection risk.

d) Keloid and Hypertrophic Scars:

These are pathological forms of excessive scarring in genetically predisposed individuals following trauma, inflammation, or surgery. Differences between the two lie in their clinical presentation, histopathology, and progression.

• Hypertrophic Scar:
  Appears within 4 weeks of injury, remains within the original wound margins, grows rapidly in early months, and often regresses spontaneously.

• Keloid Scar:
  Can form after any skin injury. These are firm, raised, pink/red to dark lesions, often shiny, and may recur after surgical removal. Silicone gel sheets are recommended to reduce collagen production and minimize recurrence.

Therapeutic Tools Used in Scar Treatment:
 

1) Manual Lymphatic Drainage (MLD):
Promotes anastomosis formation, improves lymphatic flow, and reduces tissue density in the surrounding areas.

2) Ultrasound Therapy:
Used to soften scars via thermal effects. Increases collagen extensibility, enhances neovascularization, supports phonophoresis (drug delivery via ultrasound), and accelerates hematoma and edema resolution.

3) Galvanic Current:
Creates microscopic skin lesions, triggering a strong inflammatory response that stimulates collagen production. Highly effective for atrophic scars due to its high ionization capacity.

4) Microcurrent Therapy:
Promotes rapid resolution of edema, bruising, inflammation, and pain. It inhibits matrix metalloproteinase activity, which contributes to fibrosis and tissue adhesion. Electrical stimulation enhances fibroblast proliferation and growth factor receptor expression, leading to increased collagen synthesis.

5) Dressings:
Can serve as supportive care before definitive surgical treatment or act as the primary treatment.

Types include:

• Passive: Non-adherent, hydrogels, hydrocolloids

• Active: Alginates, activated charcoal, silver-impregnated dressings

• Advanced (Smart Dressings): Negative pressure wound therapy (NPWT)