Scar formation
- Factors influencing scar formation
- Individual genetic make up
- Race
- Anatomical site
- Wound tension
- Age
- Placement of incision
- Surgical technique
- To minimise the degree of postoperative scarring:
- Incisions should run along Langer's lines
- The finest suture possible should be used
- Tension should be avoided
- Sutures should be removed as soon as possible
- Traumatic wounds should be clean and edges excised
- Exposure to sunlight should be avoided in the early postoperative period
Problematic scars
Contractures
- Result if scars shorten
- Particularly seen in badly aligned scars not corresponding to Langer's lines
- Can reduce joint mobility
- May require a z-plasty or skin graft
Depressed scars
- Result if skin becomes attached to deep tissue
- Can be treated by release of normal skin from margins of scar
- Scar is then de-epithelialised and skin edges closed over the top
Keloid and hypertrophic scars
- All scars become red and thickened during the normal healing process
- After several months maturation results in flattening of the wound
- In some scars collagen formation is excessive
- Results in elevated and red scar
- If confined to wound = hypertrophic scar
- If extends beyond wound into normal tissue = keloid scar
- Seen particularly in patients of Afro-Caribbean origin
- Particularly affects scars on the presternal and deltoid areas
- Treatment is often difficult
- Treatment options include:
- Intra-lesional steroid injections (e.g. triamcinolone)
- Compression dressings with elasticated compression garments
- Silastic gel therapy
- Excision and radiotherapy
- Laser therapy
Bibliography
Ahn S T, Monafo W W, Mustoe
T A. Topical silicone gel for the prevention and treatment of
hypertrophic scar. Arch Surg 1991;
126: 499-504.
Mustoe T A, Cooter R D, Gold M H et al. International clinical recommendations
on scar management. Plast Reconstr Surg 2002; 110: 560-571.
O'Sullivan S T, O'Connor T P, O'Shaughnessy M. Aetiology and management of hypertrophic scars. Ann R Coll
Surg 1996; 78: 168-175.
Poston J. The use of silicon gel sheeting in the management of hypertrophic and keloid scars. J
Wound Care 2000; 9: 6-10.
Rhaban S R, Garner W L. Fibroproliferative scars. Clin Plast Surg 2003;
30: 77-89 |