The Evidence for and against the Effectiveness of Pressure Garment Therapy for Scar Management
Bibliographic record
Abstract
Sir: With regard to the recently published article entitled “Review of Over-the-Counter Topical Scar Treatment Products,”1 the authors should be commended. This is an extremely important topic, as virtually every plastic surgery patient receives advice regarding scar management. The myriad of products available and the lack of high-quality scientific evidence make it difficult to provide exact advice. The aim of Shih et al.’s article was “to evaluate the evidence from published controlled clinical trials in humans on some of the most commonly used over-the-counter products for treatment of symptomatic scars.” The article states, “retrospective clinical and ultrasonic studies since the 1960s are supportive” of pressure therapy. However, of the references provided, none is a clinical study providing evidence of improved outcomes with the use of pressure garment therapy. All are case studies of patients treated with pressure therapy, and none has a comparison group or control treatment. The article goes on to state that “the only prospective, randomized study on the efficacy of pressure garments demonstrated no significant difference in wound healing” compared with control subjects.2 In addition, the article recognizes that published studies have shown that pressure therapy may in fact lead to patient morbidity. Garments can be uncomfortable and lead to skin breakdown, ulceration, and even bony deformation. Given the available evidence, one must conclude that the use of pressure therapy is not supported by the available evidence. The article states that further evidence is not available because of a lack of interest by researchers. Several centers have conducted studies to assess the effects of pressure therapy.3,4 Other studies have been conducted, but they are rarely published. This is most likely a reflection of publication bias.5 Publication bias occurs when research with statistically significant results is more likely to be submitted and published than is work with null or nonsignificant results. Given the lack of currently available evidence and the universal application of pressure therapy, I believe there is a need for adequately powered studies of high methodological quality to determine the effectiveness of pressure garment therapy. The article states, more than once, that “conducting a study on the efficacy of pressure therapy would likely be either difficult or unethical, because it would involve withholding an accepted treatment from control subjects.” The continued use of an expensive, unproven, and potentially harmful therapy without any further evidence may also be unethical. The National Institutes of Health is currently funding a large randomized control trial to assess the use of pressure therapy. It is my hope that this study will be adequately powered to shed light on this important issue. Alexander Anzarut, M.D., M.Sc. Division of Plastic and Reconstructive Surgery University of Alberta Edmonton, Alberta, Canada
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".