Page 76 - Hospital Authority Convention 2017

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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