The third (final) phase covers the period from 6-8 weeks to 1.5-2 years after surgery. The period up to 2 years after surgery is considered the time when the greatest remodelling of the scar is possible. Improvement at a later time is also possible, but to a much lesser extent. In the third phase, the formation of adhesions can be assessed. In the third phase, the formation of adhesions can be assessed. The scar should move independently of the deeper-lying tissues and should lift as part of the skin (it must not pull the deeper-lying tissues with it). To assess this, the therapist performs a sliding test and a lifting test of the scar.

The manual techniques in the third period are stronger and more forceful than those in the previous period.

In phase III we can use the following techniques and methods:

• deep massage and more forceful myofascial release techniques
• manual techniques such as moving the scar in different directions, rolling the scar, pulling the tissues away, breaking the scar, stretching the tissues adjacent to the scar, releasing the scar
• kinesitherapy – exercises to mobilise the scar area, increase the mobility of muscles and other soft tissues
• kinesiotaping – ligament application, fascial application, lymphatic application
• dry brushing

During manual work with the scar, lubricants should not be used, as they may hinder contact with the tissue and its deformation. However, after the end of therapy and as part of self-therapy, ointments or creams for scars should be used.

It is important to teach the patient self-therapy and continue therapy at home.

In scar therapy, we can additionally use physical therapy. Infrared light is used in scar regeneration and remodelling, iontophoresis with potassium iodide or sodium chloride – to congest and soften tissues, ultrasound (especially with collagen ointment) – to promote remodelling, laser therapy – accelerates wound healing and promotes collagen synthesis.

Cosmetic treatments such as microdermabrasion and chemical peels can also be used to treat scars.

Antonina Kaczorowska

References:

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3. Chochowska M. Praca z blizną po operacji cesarskiego cięcia. Rehabilitacja w praktyce 2018; 5: 36-42.
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