From the Guidelines
Post-excision scar management should prioritize a comprehensive approach to optimize healing and minimize complications, with a focus on maintaining a moist healing environment, regulating collagen production, and addressing the inflammatory response, collagen remodeling, and mechanical forces that influence scar formation, as supported by the most recent and highest quality studies, including 1 and 1.
Key Considerations
- Initially, keep the wound clean and covered with appropriate dressings, changing them as directed by your surgeon, typically for 1-2 weeks until sutures are removed.
- Apply petroleum jelly or antibiotic ointment as prescribed to maintain a moist healing environment.
- Once the incision has closed, silicone-based products (sheets or gel) should be applied daily for at least 12 hours per day for 2-3 months, as they have proven efficacy in reducing scar formation by regulating collagen production, as noted in 1.
Scar Management Techniques
- Massage the scar gently for 5-10 minutes, 2-3 times daily using firm circular motions to break down adhesions and improve appearance.
- Sun protection is crucial—apply SPF 30+ sunscreen to prevent hyperpigmentation for at least 12 months.
- For hypertrophic or keloid scars, intralesional steroid injections (triamcinolone 10-40 mg/ml) may be administered every 4-6 weeks, as mentioned in 1.
- Pressure therapy using compression garments for 12-23 hours daily for 6-12 months can be beneficial for larger scars.
Additional Interventions
- For persistent problematic scars, additional interventions like laser therapy, dermabrasion, or surgical revision may be considered after the scar has fully matured, typically 12-18 months post-surgery, as suggested by 1.
- The choice of wound closure technique, such as split-skin grafting, autologous skin grafting, or healing by secondary intention, may depend on anatomical considerations and the availability of suitable donor skin, as discussed in 1 and 1.
From the Research
Post-Excision Scar Surgical Management
- The management of surgical scars is a crucial aspect of postoperative care, with the goal of creating an ideal scar that is flat, thin, and color-matched to the surrounding skin 2.
- Several surgical and nonsurgical options exist for the treatment of scars, including silicone gel sheeting, pressure garments, and intralesional steroid injections 3, 4.
- The choice of treatment depends on the location, quality, and size of the scar, as well as patient history, preferences, and expectations 2.
Silicone Gel Sheeting
- Silicone gel sheeting is a commonly used treatment for hypertrophic and keloid scars, with some studies suggesting its effectiveness in reducing scar severity and pain 3, 4.
- However, the evidence is largely based on low-certainty studies, and further research is needed to fully understand the benefits and limitations of silicone gel sheeting 3, 4.
Multimodal Perioperative Intervention
- A multimodal approach to scar management, including preoperative, intraoperative, and postoperative interventions, may be beneficial in optimizing scar outcomes 5.
- This approach can include lifestyle modifications, optimization of medical comorbidities, meticulous operative techniques, and personalized postoperative care 5.
Scar Prevention and Management
- The management of surgical scars begins with a thorough informed consent process and continues through the stages of wound healing 6.
- Patient participation and education are crucial in obtaining optimal outcomes, and early intervention is key to controlling hyperplastic response 6.
- Hypertrophic scars that do not improve by 6 months may be considered keloids and should be managed aggressively with intralesional steroid injections and alternate modalities 6.