A Novel Bespoke Hypertrophic Scar Treatment: Actualizing Hybrid Pressure and Silicone Therapies with 3D Printing and Scanning

Lung Chow, Kit-lun Yick, Yue Sun, Matthew S.H. Leung, Mei-ying Kwan, Sun-pui Ng, Annie Yu, Joanne Yip, Ying-fan Chan

Article ID: 327
Vol 7, Issue 1, 2021, Article identifier:327

VIEWS - 154 (Abstract) 19 (PDF) 3 (Supp.File)


The treatment of hypertrophic scars (HSs) is considered to be the most challenging task in wound rehabilitation. Conventional silicone sheet therapy has a positive effect on the healing process of HSs. However, the dimensions of the silicone sheet are typically larger than those of the HS itself which may negatively impact the healthy skin that surrounds the HS. Furthermore, the debonding and displacement of the silicone sheet from the skin are critical problems that affect treatment compliance. Herein, we propose a bespoke HS treatment design that integrates pressure sleeve with a silicone sheet and use of silicone gel using a workflow of three-dimensional (3D) printing, 3D scanning and computer-aided design, and manufacturing software. A finite element analysis (FEA) is used to optimize the control of the pressure distribution and investigate the effects of the silicone elastomer. The result shows that the silicone elastomer increases the amount of exerted pressure on the HS and minimizes unnecessary pressure to other parts of the wrist. Based on this treatment design, a silicone elastomer that perfectly conforms to an HS is printed and attached onto a customized pressure sleeve. Most importantly, unlimited scar treating gel can be applied as the means to optimize treatment of HSs while the silicone sheet is firmly affixed and secured by the pressure sleeve.


Surgical scars; Hypertrophic scars; Finite element analysis; 3D-printing; 3D-scanning

Full Text:

PDF , File


Ogawa R, 2020, Total Scar Management: From Lasers to Surgery for Scars, Keloids, and Scar Contractures. Springer, Singapore. https://doi.org/10.1007/978-981-32-9791-3

Tredget EE, Nedelec B, Scott PG, et al., 1997, Hypertrophic Scars, Keloids, and Contractures: The Cellular and Molecular Basis for Therapy. Surg Clin North Am, 77(3):701–30. https://doi.org/10.1016/s0039-6109(05)70576-4

Grose R, Werner S, 2004, Wound-healing Studies in Transgenic and Knockout Mice. Appl Biochem Biotechnol Part B Mol Biotechnol, 28(2):147–66. https://doi.org/10.1385/mb:28:2:147

Son D, Harijan A, 2014, Overview of Surgical Scar Prevention and Management. J Korean Med Sci, 29(6):751–7. https://doi.org/10.3346/jkms.2014.29.6.751

Enoch S, Leaper DJ, 2008, Basic Science of Wound Healing. Surgery (Oxford), 26(2):31–7. https://doi.org/10.1016/j.mpsur.2007.11.005

Werner S, Krieg T, Smola H, 2007, Keratinocyte-fibroblast Interactions in Wound Healing. J Investig Dermatol, 127(5):998–1008. https://doi.org/10.1038/sj.jid.5700786

Nagase H, Woessner JF, 1999, Matrix Metalloproteinases. J Biol Chem, 274(31):21491–4. https://doi.org/10.1074/jbc.274.31.21491

Bock O, Schmid-Ott G, Malewski P, et al., 2006, Quality of Life of Patients with Keloid and Hypertrophic Scarring. Arch Dermatol Res, 297(10):433–8. https://doi.org/10.1007/s00403-006-0651-7

Mazharinia N, Aghaei S, Shayan Z, 2007, Dermatology life quality index (DLQI) scores in burn victims after revival. J Burn Care Res, 28(2):312–7. https://doi.org/10.1097/bcr.0b013e318031a151

Kwan P, Hori K, Ding J, et al., 2009, Scar and Contracture: Biological Principles. Hand Clin, 25(4):511–28. https://doi.org/10.1016/j.hcl.2009.06.007

van Vlimmeren MA, Driessen-Mol A, van Den Broek M, et al., 2010, Controlling matrix formation and cross-linking by hypoxia in cardiovascular tissue engineering. J Appl Physiol (Bethesda, Md. 1985), 109(5):1483. https://doi.org/10.1152/japplphysiol.00571.2010

Teekakirikul P, Eminaga S, Toka O, et al., 2010, Cardiac Fibrosis in Mice with Hypertrophic Cardiomyopathy is Mediated by Non-myocyte Proliferation and Requires Tgf- [Beta]. J Clin Investig, 120(10):3520–9. https://doi.org/10.1172/jci42028

Kassebaum NJ, Arora M, Barber RM, et al., 2016, Global, Regional, and National Disability-adjusted Life-years (DALYs) for 315 Diseases and Injuries and Healthy Life Expectancy (HALE), 1990-2015: A Systematic Analysis for the Global Burden of Disease Study 2015. Lancet, 388(10053):1603–58. https://doi.org/10.3410/f.726827339.793524296

Li-Tsang CW, Lau JC, Chan CH, 2005, Prevalence of Hypertrophic Scar Formation and its Characteristics among the Chinese Population. Burns, 31(5):610–6. https://doi.org/10.1016/j.burns.2005.01.022

Block L, Gosain A, King TW, 2015, Emerging Therapies for Scar Prevention. Adv Wound Care (New Rochelle), 4(10):607–614. https://doi.org/10.1089/wound.2015.0646

Puzey G, 2002, The Use, of Pressure Garments on Hypertrophic Scars. J. Tissue Viability, 12(1):11–5. https://doi.org/10.1016/s0965-206x(02)80004-3

Perkins K, Davey R, Wallis K, 1983, Silicone Gel: A New Treatment for Burn Scars and Contractures. Burns, 9(3):201–4. https://doi.org/10.1016/0305-4179(83)90039-6

Leung P, Ng M, 1980, Pressure Treatment for Hypertrophic Scars Resulting from Burns. Burns, 6(4):244–50. https://doi.org/10.1016/s0305-4179(80)80007-6

Rivers E, Strate R, Solem L, 1979, The Transparent Face Mask. Am J Occup Ther, 33(2):108–13.

Staley MJ, Richard RL, 1997, Use of Pressure to Treat Hypertrophic Burn Scars. Adv Wound Care, 10(3):44–6.

Ai JW, Liu JT, Pei SD, et al., 2017, The Effectiveness of Pressure Therapy (15-25 mmHg) for Hypertrophic Burn Scars: A Systematic Review and Meta-analysis. Sci Rep, 7(1):40185. https://doi.org/10.1038/srep40185

Wolfram D, Tzankov A, Pülzl P, et al., 2009, Hypertrophic Scars and Keloids a Review of Their Pathophysiology, Risk Factors, and Therapeutic Management. Dermatol Surg, 35(2):171–81. https://doi.org/10.1111/j.1524-4725.2008.34406.x

Klöti J, Pochon J, 1982, Conservative Treatment Using Compression Suits for Second and Third Degree Burns in Children. Burns, 8(3):180–7. https://doi.org/10.1016/0305-4179(82)90085-7

Pratt J, 1995, In: West G, Withinshaw B, editors. Pressure Garments: A Manual on Their Design and Fabrication. 1st ed. Butterworth-Heinemann, Oxford, Boston.

Hoeksema H, De Vos M, Verbelen J, et al., 2013, Scar Management by Means of Occlusion and Hydration: A Comparative Study of Silicones Versus a Hydrating Gel-cream. Burns, 39(7):1437–48. https://doi.org/10.1016/j.burns.2013.03.025

Van den Kerckhove E, Stappaerts K, Boeckx W, et al., 2001, Silicones in the Rehabilitation of Burns: A Review and Overview. Burns, 27(3):205–14. https://doi.org/10.1016/s0305-4179(00)00102-9

Gilman TH, 2003, Silicone Sheet for Treatment and Prevention of Hypertrophic Scar: A New Proposal for the Mechanism of Efficacy. Wound Repair Regen, 11(3):235–6. https://doi.org/10.1046/j.1524-475x.2003.11313.x

Ko WJ, Na YC, Suh BS, et al., 2013, The Effects of Topical Agent (kelo-cote or contractubex) Massage on the Thickness of Post-burn Scar Tissue Formed in Rats. Arch Plast Surg, 40(6):697–704. https://doi.org/10.5999/aps.2013.40.6.697

Berman B, Perez OA, Konda S, et al., 2007, A Review of the Biologic Effects, Clinical Efficacy, and Safety of Silicone Elastomer Sheeting for Hypertrophic and Keloid Scar Treatment and Management. Malden, USA, pp. 1291–303. https://doi.org/10.1111/j.1524-4725.2007.33280.x

Saulis AS, Chao JD, Telser A, et al., 2002, Silicone Occlusive Treatment of Hypertrophic Scar in the Rabbit Model. Aesthetic Surg J, 22(2):147–53. https://doi.org/10.1067/maj.2002.123023

Li-Tsang CW, Lau JC, Choi J, et al., 2006, A Prospective Randomized Clinical Trial to Investigate the Effect of Silicone Gel Sheeting (Cica-Care) on Post-traumatic Hypertrophic Scar among the Chinese Population. Burns, 32(6):678–83. https://doi.org/10.1016/j.burns.2006.01.016

Puri N, Talwar A, 2009, The Efficacy of Silicone Gel for the Treatment of Hypertrophic Scars and Keloids. J Cutan Aesthet Surg, 2(2):104–6. https://doi.org/10.4103/0974-2077.58527

Yu A, Yick KL, Ng SP, et al., 2016, Orthopaedic Textile Inserts for Pressure Treatment of Hypertrophic Scars. Textile Res J, 86(14):1549–62. https://doi.org/10.1177/0040517515573409

Li-Tsang CW, Zheng YP, Lau JC, 2010, A Randomized Clinical Trial to Study the Effect of Silicone Gel Dressing and Pressure Therapy on Posttraumatic Hypertrophic Scars. J Burn Care Res, 31(3):448–57. https://doi.org/10.1097/bcr.0b013e3181db52a7

Muangman P, Kongkor A, Namviriyachote N, et al., 2020, Effectiveness of Silicone Gel Combined with Pressure Garment for Prevention of Post-Burn Hypertrophic Scar: A Randomized Controlled Trial. J Med Assoc Thailand, 103(5):39–43.

Uslu A, Sürücü A, Korkmaz MA, et al., 2019, Acquired Localized Hypertrichosis Following Pressure Garment and/or Silicone Therapy in Burn Patients. Ann Plast Surg, 82(2):158–61. https://doi.org/10.1097/sap.0000000000001686

Ng WL, Chan A, Ong YS, et al., 2020, Deep Learning for Fabrication and Maturation of 3D Bioprinted Tissues and Organs. Virtual Phys Prototyp, 15(3):340–58.

Sun W, Starly B, Daly AC, et al., 2020, The Bioprinting Roadmap. Biofabrication, 12(2):5158.

Ng WL, Chua CK, Shen YF, 2019, Print Me An Organ! Why We Are Not There Yet. Prog Polym Sci, 97:101145. https://doi.org/10.1016/j.progpolymsci.2019.101145

Kang HW, Lee SJ, Ko IK, et al., 2016, A 3D Bioprinting System to Produce Human-scale Tissue Constructs with Structural Integrity. Nat Biotechnol, 34(3):312–9. https://doi.org/10.1038/nbt.3413

Oladapo BI, Ismail SO, Afolalu TD, et al., 2021, Review on 3D Printing: Fight against COVID-19. Mater Chem Phys, 258:123943. https://doi.org/10.1016/j.matchemphys.2020.123943

Rendeki S, Nagy B, Bene M, et al., 2020, An Overview on Personal Protective Equipment (PPE) Fabricated with Additive Manufacturing Technologies in the Era of COVID-19 Pandemic. Polymers, 12(11):1–18. https://doi.org/10.3390/polym12112703

Hale L, Linley E, Kalaskar DM, 2020, A Digital Workflow for Design and Fabrication of Bespoke Orthoses Using 3D Scanning and 3D Printing, a Patient-based Case Study. Sci Rep, 10(1):7028–7. https://doi.org/10.1038/s41598-020-63937-1

Zolfagharian A, Gregory TM, Bodaghi M, et al., 2020, Patient-Specific 3D-printed Splint for Mallet Finger Injury. Int J Bioprint, 6(2):1–13. https://doi.org/10.18063/ijb.v6i2.259

Holt SG, Yo JH, Karschimkus C, et al., 2020, Monitoring Skin Temperature at the Wrist in Hospitalised Patients May Assist in the Detection of Infection. Intern Med J, 50(6):685–90. https://doi.org/10.1111/imj.14748

Chen G, Xie J, Dai G, et al., 2020, Validity of the Use of Wrist and Forehead Temperatures in Screening the General Population for COVID-19: A Prospective Real-World Study. Iran J Public Health, 49(supple 1):3670. https://doi.org/10.18502/ijph.v49is1.3670

Chow L, Yick KL, Kwan MY, et al., 2020, Customized Fabrication Approach for Hypertrophic Scar Treatment: 3D Printed Fabric Silicone Composite. Int J Bioprint, 6(2):262. https://doi.org/10.18063/ijb.v6i2.262

Boone LA, 1995, Development of a Customized Pattern Drafting System for Interim Burnscar Pressure Garments Utilizing Fabric Properties and Circumference Measurements. University of Alberta, Edmonton, Alta.

Yu A, 2015, Development of Pressure Therapy Gloves for Hypertrophic Scar Treatment. The Hong Kong Polytechnic University, Hong Kong.

Yu A, Yick KL, Ng SP, et al., 2016, Numerical Simulation of Pressure Therapy Glove by Using Finite Element Method. Burns, 42(1):141–51. https://doi.org/10.1016/j.burns.2015.09.013

Wu JZ, Dong RG, Rakheja S, et al., 2002, Simulation of Mechanical Responses of Fingertip to Dynamic Loading. Med Eng Phys, 24(4):253–64.

Lai CH, Li-Tsang CW, 2009, Validation of the Pliance X System in measuring interface pressure generated by pressure garment. Burns, 35(6):845–51. https://doi.org/10.1016/j.burns.2008.09.013

Wiseman J, Simons M, Kimble R, et al., 2018, Reliability and Clinical Utility of the Pliance X for Measuring Pressure at the Interface of Pressure Garments and Burn Scars in Children. Burns, 44(7):1820–8. https://doi.org/10.1016/j.burns.2018.05.002

Reid W, Evans J, Naismith R, et al., 1987, Hypertrophic Scarring and Pressure Therapy. Burns, 13:S29–32. https://doi.org/10.1016/0305-4179(87)90090-8

Leung K, Cheng J, Ma G, et al., 1984, Complications of Pressure Therapy for Post-burn Hypertrophic Scars: Biomechanical Analysis Based on 5 Patients. Burns, 10(6):434–8. https://doi.org/10.1016/0305-4179(84)90085-8

Miyatsuji A, Matsumoto T, Mitarai S, et al., 2002, Effects of Clothing Pressure Caused by Different Types of Brassieres on Autonomic Nervous System Activity Evaluated by Heart Rate Variability Power Spectral Analysis. J Physiol Anthropol Appl Hum Sci, 21(1):67–74. https://doi.org/10.2114/jpa.21.67

DOI: http://dx.doi.org/10.18063/ijb.v7i1.327


  • There are currently no refbacks.

Copyright (c) 2021 Lung CHOW, Kit-lun Yick, Yue Sun, Sin Hang Matthew Leung, Mei Ying Kwan, Sun Pui Ng, Annie Yu, Joanne Yip, Ying Fan CHAN

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.