Introduction: Silicone is a common treatment used to manage hypertrophic scarring (Mustoe; 2008; Nedelec; 2015). It comes in a variety of forms including sprays, gels and gel sheets. Gel sheets are most commonly used at our burn center and have been shown to correlate with improved scar outcome when applied early after burn injury (Parry, 2013). However, gel sheets are often difficult to use because they lose their adhesive qualities resulting in the sheets falling off or slipping out of place or they get lost with the constant need to remove and clean. The goal of this quality improvement project was to trial a thinner and more adhesive silicone sheet and determine its feasibility.

Methods: A new ultra-thin, clear and adhesive silicone gel sheet layered on a semi-permeable polyester backing was trialed. The silicone is designed to be a one-time application, eliminating the need for daily removal and cleaning. The silicone sheets were applied to clean scar sites and patients were instructed to leave it in place during all activities (bathing, exercise, etc.) until it falls off naturally. Complications were monitored (rash, redness, itching, dermatitis). The Patient Observer Scar Assessment Scale (POSAS) was administered on day 1 and within 3 days after the silicone had fallen off.

Results: The silicone gel sheet was used on 19 scar sites in 8 pediatric burn patients. The average age was 7.3 years, average TBSA was 50.6%, and average scar age of the sites treated was 212.5 days. The silicone was used on a variety of body areas and stayed in place for an average of 13.8 days and no complications we observed or reported during the duration of wear. The scar assessment showed significant improvements for both the patient report (16.3 points, p<0.05 ) and the observer (5.1 points, p<0.05).

Discussion: It appears that this thin, clear, adhesive silicone gel sheet product that is designed to be secured without the need to change and clean has good feasibility of use, stays in place and can improve scars over time without complications.

Conclusion: This QI project suggests that the new silicone gel sheet trialed has significant potential benefit to patients in terms of feasibility of use as well as scar improvement and should undergo formal investigation.

References and Resources

1. Mustoe TA (2008) Evolution of silicone therapy and mechanism of action in scar management. Aesth Plast Surg 32:82–92
2. Nedelec, B et al (2015) Practice Guidelines for the Application of Nonsilicone or Silicone Gels and Gel Sheets After Burn Injury J Burn Care Res;36:345–374)
3. Parry, IP et al (2013) Nonsurgical Scar Management of the Face: Does Early Versus Late Intervention Affect Outcome? J Burn Care Res;34:569–575)