Page 222 - Hospital Authority Convention 2017
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Service Enhancement Presentations
      HOSPITAL AUTHORITY CONVENTION 2017


             F6.7      Enhancing Partnership with Patients and Community                10:45  Room 421

            Home Care Programme for Prevention of Hypertrophic Scar in Primary Cleft Lip Repair
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            Tong PL , Chow CY , Wong WM , Chan KM , Chan YF , Wu A , Ma PK , Fung G , Chan HB , Pang P , Chao N , Liu K  2
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             Department of Paediatrics and Adolescent Medicine,  Cleft Lip and Palate Service, Department of Surgery, United Christian
            Hospital, Hong Kong
            Introduction
            Cleft lip and palate is a common congenital malformation with a frequency of around one in 700 live births. Children with cleft
            lip deformity face multiple physical and psychosocial problems associated with facial disfigurement. Treatment process is
            long and arduous and demands care from a multi-disciplinary team.
            Cleft lip scars after surgical repair often become hypertrophic or discoloured thus compromising the clinical results.
            Surgical scar formation occurs in three sequential and overlapping phases: inflammation, proliferation and remodeling. They
            are targets of various scar treatment modalities which include Pulsed Dye Laser (PDL), Intra lesson Botox injection, scar
            massage, application of silicone-gel and silicone-gel sheet.
            The  Cleft  Lip  And  Palate  Service (CLAPS) in  United Christian  Hospital provides regional  cross-clusters multi-disciplinary
            cleft care. Patients with cleft lip referred to our hospital for surgical care are managed in Neonatal Unit and Multi-disciplinary
            Clinic for peri-operative care as well as parental education for subsequent home-based care. The education programme
            includes pre-operative lip-taping, feeding and post-operative scar massage techniques, application of silicone-gel, silicone-
            sheet and nasal retainer. Based on resourcefulness and knowledge in scar care, the CLAPS nurses lead different roles in the
            education process, including multi-disciplinary coordination and planning, counseling, education and assessment in ensuring
            knowledge, skills, confidence and compliance by care-givers in pursuing scar care at home.
            Objectives
            To review the effectiveness in preventing hypertrophic scar after the home care education programme for infants with cleft lip
            repair.

            Methodology
            We conducted a retrospective review of clinical photos and scar assessment data in consultation records including objective
            colorimetry using skin pigmentation analyser and scar pliability and thickness as scored by Vancouver Scar Scale. Patients
            receiving repair of cleft lip from February 2012 to January 2016 at our hospital who underwent scar treatment programme
            were included in this study. The key post-operative scar management as coordinated by designated CLAPS nurse include:
            (1)  Regular combined-clinic follow-up at 1, 2, 6, 10, 14, and 24 weeks after surgery and suture removal, which facilitate:
            (2)  Education to care-givers regarding home-based treatment: daily scar massage, application of silicone-gel and silicone-
                sheet for at least six months.
            (3)  Scar assessment by surgeon and trained nurse. Study parameters during follow-up include: (a) scar color and
                pigmentation measured by colorimeter; (b) pliability and thickness measured by Vancouver Scar Scale.
      Wednesday, 17 May  A total of 45 children underwent surgical repair of cleft lip and nurse-led home care education programme during the study
            Results

            period. 26/45 (58%) of the children showed improvement in erythema gauge range: 84-55 unit initial post-operation vs 62-
            51u post-scar-treatment programme. 29/45(64%) had flat scars after six months (mean VSS thickness score 3. The mean VSS
            Pliability Score improved from 5 to 3.

            Conclusion
            The results show that scar management home care training programme via regular CLAPS Clinic follow-up ensures caregiver
            to  maintain  care  to  patient  with  skill  and  knowledge  that  they  learnt  in  the  programme,  preventing  scar  hypertrophy  and
            contributing to optimal surgical outcomes in cleft lip patients.




















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