Using Lymphedema Treatment Techniques for Scar Management

Written by: Elizabeth Bonorden, OTR/L

Virtual Hand Therapy Fellow'25/'26

“There’s just so much scar.”

And indeed, there was. From the patient’s forearms to the web spaces of each finger, there were tight swathes of uneven, overlapping scar tissue—a result of burns and grafts. His primary therapist had asked me to look over his hands to see what more could possibly be done, particularly for the tight scar tissue in his web spaces, which had made it difficult for him to grasp items efficiently.

They had gone the traditional route of massage—both with their hands and a mini-massager tool—along with cupping and taping. Everything they could think of, they had tried, and his fingers were still just so tight.

“Why don’t we try something a little different? It’s a technique I use in lymphedema for fibrosis, but it may work here too.”

I went to our supply closet and grabbed some thin CompriFoam, Mollelast, and paper tape. I started cutting small, arrow-shaped pieces out of the CompriFoam and secured the “legs” of the arrows around every other finger with paper tape. I then wrapped the fingers with Mollelast, using the lymphedema techniques I had been taught during my certification. The patient was encouraged to wear them until he returned in two days’ time.

When he arrived at the clinic, the scars in the web spaces had, to our surprise and delight, flattened, and he was able to demonstrate more finger abduction than he had two days prior.

This wasn’t the only lymphedema treatment technique traditionally used for fibrosis that we would use with this patient. In the end, we were able to flatten much of his scar tissue and reduce many of the issues he had been experiencing because of it.

Fibrosis Vs. Scar Tissue

I view fibrosis and scar tissue as cousins. Both involve stimulated fibroblasts laying down connective tissue in areas of damage caused by inflammation, trauma, disease, or surgery. Both can involve the buildup of extracellular matrix proteins, particularly collagen, as part of the healing response.

One distinction is that scar tissue is generally localized and typically matures over time, although hypertrophic and keloid scars can behave differently. Fibrosis, on the other hand, can involve a more persistent process in which excess connective tissue continues to accumulate.

It is because of these similarities that many of the lymphedema treatments used to address fibrosis may also be useful when managing stubborn scar tissue. For this blog, I will focus particularly on the use of foam/chip bags and shockwave therapy.

Foam and Chip Bags

Various foam products are used in lymphedema treatment, but the ones I use most often in scar management are CompriFoam, Gray Foam, and Yellow Foam.

CompriFoam is very thin and flexible. Because of this, it can contour well to hard-to-reach, delicate areas of scar tissue, such as the web spaces of the fingers. It works similarly to elastomer and silicone sheeting in that it delivers focal pressure directly onto the scars. Where it differs is that it can provide a light layer of warmth and mechanical variation, which may aid in managing micro-scars as well as localized edema (Wietlisbach, 2020).

Chip bags, as they are called in the lymphedema world, are pads filled with shredded foam “chips” of Gray and Yellow Foam. Generally, they are used in lymphedema treatment to assist with brawny swelling and fibrosis under bandage wraps, but they can also assist with scar management in much the same way that CompriFoam can.

Anecdotally, I like to use these on much broader surfaces. Also, because of the variation in foam textures, I can customize the amount of pressure I want to provide to the area based on the ratio of Gray and Yellow Foam used. The more raised and firm the scar is, the more Yellow Foam I will place into the chip bag.

Shockwave Therapy

Extracorporeal shockwave therapy (ESWT), or shockwave therapy, is a non-invasive procedure that uses an applicator head to deliver acoustic waves to the affected area. A gel, similar to ultrasound gel, is used as a medium to assist with the transmission of these waves into the tissue. ESWT is thought to influence scar tissue through mechanotransduction, promoting tissue regeneration and matrix remodeling (Moortgat et al., 2020).

Treatment protocols vary depending on the equipment, scar, and treatment parameters being used. Some studies have used treatments once weekly for up to 10 sessions. The sensation can be described as rhythmic tapping or mild discomfort over the scarred area.

Several studies examining the effectiveness of ESWT on scars have reported beneficial results. A systematic review conducted in 2024 examined 12 research articles concerning ESWT treatment for hypertrophic and keloid scars. In regard to keloid scarring, ESWT produced outcomes comparable to intralesional steroid treatment in the studies reviewed (Gili et al., 2024).

In addition, improvements in scar appearance, elasticity, thickness, discomfort, and function have been reported in hypertrophic scars, suggesting that ESWT may be a useful addition to scar management (Gili et al., 2024).

Conclusion

Although lymphedema treatment and hand therapy may seem like they live at opposite ends of the therapy world, the two disciplines share many similarities in their approaches to tissue and scar management.

By recognizing and understanding the similarities between fibrosis and scar tissue, hand therapists may be able to incorporate techniques traditionally used for stubborn fibrosis when treating patients with more challenging scars.

For some patients, these techniques can provide another option when traditional scar management approaches alone have not produced the desired changes, with the potential to improve both the appearance of the scar and function.

References

Gili, N., Micallef Stafrace, K., Laybats, F., & Mifsud, T. (2024a). The role of Extracorporeal Shock Wave Therapy in Keloids and hypertrophic scars: A systematic review. Cureus. https://doi.org/10.7759/cureus.71869

Moortgat, P., Anthonissen, M., Van Daele, U., Meirte, J., Vanhullebusch, T., & Maertens, K. (2020). 55:  Shock Wave Therapy for Wound Healing and Scar Treatment. In Textbook on Scar Management: State of the Art Management and Emerging Technologies. essay, Springer.

Seung, Y.L., Yoon, S.C., Cheong, H.S., Jisu, S., So, Y.J. Extracorporeal shock wave therapy administered to patients with burns [Photograph]. https://pmc.ncbi.nlm.nih.gov/articles/PMC11634145/

Warthman, R., Martinez, A., & Meshanko, J. (2021). Chip Bag Technique [Photograph]. https://www.sciencedirect.com/science/article/pii/S2468912221000675

Wietlisbach, C. M. (2020). COOPER’S FUNDAMENTALS OF HAND THERAPY : clinical reasoning and treatment guidelines for common... diagnoses of the upper extremity. (3rd ed.). Mosby.