What interventions reduce scar formation after a skin injury or surgical incision?

Minimizing Scarring After Skin Injury or Surgery

Use silicone sheeting or gel as first-line prophylaxis and treatment for all scars, combined with meticulous surgical technique including subcuticular continuous sutures and triclosan-coated sutures when closing wounds. 1

Preoperative Planning to Prevent Scarring

Optimize incision planning and patient preparation:

• Plan incisions along relaxation skin tension lines to minimize mechanical stress on healing tissue 2, 1
• Perform preoperative skin preparation with alcohol-based antiseptic agents to reduce infection risk, which directly impacts scar quality 3
• Consider perioperative nasal and skin decolonization when possible, particularly for high-risk patients 3
• Ensure patients shower with soap (antimicrobial or non-antimicrobial) before surgery 3

Intraoperative Techniques That Reduce Scarring

Closure technique is critical:

• Use subcuticular continuous sutures rather than staples or interrupted sutures, as they significantly reduce surgical site infection rates (1.8% vs 10.0%, P < 0.01), and infection is a major driver of poor scarring 3
• Use triclosan-coated sutures instead of non-coated sutures (Grade 1B recommendation), as they significantly reduce surgical site infection prevalence (OR 0.72,95% CI 0.59–0.88, P = 0.001), thereby improving scar outcomes 3
• Avoid tissue adhesives for wound closure, as they have 3.35 times higher risk of wound dehiscence compared to sutures (RR 3.35; 95% CI 1.53 to 7.33), which worsens scarring 3
• Do not add adhesive steri-strips to subcuticular sutures, as they provide no benefit for scar width (both 1.1 mm, P = .89) or cosmetic outcomes 3

For high-risk surgical incisions:

• Apply incisional negative pressure wound therapy for high-risk wounds (pilon, plateau, or calcaneus fractures) to reduce deep infection and improve healing 3

Postoperative Scar Prevention Protocol

Immediate post-closure management (0-48 hours):

• Keep surgical dressing undisturbed for minimum 48 hours unless leakage occurs 4
• No evidence supports extending dressing time beyond 48 hours for scar prevention 4
• After 48 hours or suture removal, leave well-approximated wounds open to air unless drainage persists 5

Early scar management (days to weeks):

• Apply silicone sheeting or gel immediately after wound closure and continue for months - this is the gold-standard, first-line prophylactic treatment with demonstrated efficacy and safety in multiple clinical studies 1
• Reduce skin tension through taping techniques to minimize mechanical stress on healing tissue 1
• Provide hydration to early scar tissue using moisturizers 1, 6
• Ensure strict UV protection of healing wounds, as sun exposure causes hyperpigmentation and hypertrophic changes 1
• Allow gentle washing with soap and water once wound edges are sealed, ensuring thorough drying afterward 5

Ongoing scar management (weeks to months):

• Continue silicone therapy for extended periods (typically 3-6 months minimum) 1
• Initiate early massage using topical corticosteroids or anti-inflammatory moisturizers to control inflammation that drives hyperpigmentation and hypertrophy 6
• Consider pressure garments for widespread scarring, especially after burns 1

High-Risk Patient Considerations

For patients at increased risk of pathological scarring (keloids, hypertrophic scars):

• Implement all preventive measures above with particular attention to silicone therapy 1
• More aggressive early intervention is warranted, as skin of color patients have higher risk of excessive scarring 7
• Consider specialized scar treatment options beyond standard silicone therapy for high-risk patients 1

Critical Pitfalls to Avoid

Do not:

• Use staples or interrupted sutures when subcuticular continuous sutures are feasible 3
• Use non-coated sutures when triclosan-coated options are available 3
• Apply tissue adhesives for definitive wound closure 3
• Neglect silicone therapy - it is universally considered first-line prevention 1
• Allow sun exposure to healing wounds without protection 1
• Delay intervention for inflammation, as early control prevents hyperpigmentation and hypertrophy 6

Evidence Quality Note

While the evidence for specific closure techniques is strong (Grade 1B for triclosan-coated sutures) 3, many postoperative interventions require further high-quality research with larger sample sizes 3. However, silicone therapy stands out as having consistent evidence across multiple studies as the gold-standard non-invasive approach 1.