Scar Appearance After Revision Broström Surgery
After revision Broström ankle ligament repair, the surgical scar typically undergoes normal wound healing and maturation rather than becoming permanently darker, though temporary hyperpigmentation or inflammation may occur during the healing phase.
Expected Scar Changes After Revision Surgery
Normal Scar Maturation Process
- Surgical scars do not inherently darken after revision procedures, but they follow a predictable maturation timeline where initial inflammation and redness gradually fade over 12-18 months 1
- The scar may appear temporarily darker or more erythematous during the first 3-6 months post-revision due to increased vascularity and inflammatory response during active healing 1
- Scar tissue from the initial Broström procedure is typically excised during revision surgery, meaning you're essentially creating a new scar rather than layering over the old one 2, 3
Factors Affecting Scar Appearance
- Skin type and pigmentation significantly influence scar appearance, with individuals of darker complexion at higher risk for post-inflammatory hyperpigmentation or hypopigmentation 4
- Tension on the wound edges during healing can lead to hypertrophic scarring or keloid formation, which may appear raised and darker 1
- Surgical technique matters: Modern Broström repairs using suture anchors typically result in smaller, more cosmetically favorable scars compared to older techniques 5, 3, 6
Timeline for Scar Maturation
- First 6 months: Scar appears red, raised, and potentially darker due to active collagen remodeling and increased blood flow 1
- 6-12 months: Progressive flattening and fading of the scar as inflammation subsides 1
- 12-18 months: Final scar appearance achieved, typically appearing as a thin, pale line if healing is uncomplicated 1
Management of Problematic Scars
First-Line Interventions
- Intralesional corticosteroid injections are the primary treatment for hypertrophic scars or keloids that appear raised or darkened 1
- Topical corticosteroid ointments or tapes can reduce inflammation in the reticular dermis and prevent excessive scar formation 1
Second-Line Options for Refractory Cases
- Pulsed-dye laser therapy can effectively treat persistent vascular ectasias or redness in mature scars 4, 1
- OnabotulinumtoxinA injections may be considered for resistant hypertrophic scarring 1
- Intralesional cryotherapy is another option for refractory cases 1
Common Pitfalls to Avoid
- Avoid aggressive sun exposure during the first year post-surgery, as UV radiation can cause permanent hyperpigmentation of healing scars, particularly in darker skin types 4
- Do not assume darkening indicates infection or recurrence without other clinical signs such as warmth, fluctuance, drainage, or progressive growth 7
- Distinguish between normal scar maturation and pathologic scarring: If the scar becomes progressively raised, symptomatic, or extends beyond the original wound margins after 6 months, consider hypertrophic scar or keloid formation requiring intervention 1
When to Seek Further Evaluation
- Progressive darkening with nodularity or growth beyond 6 months warrants biopsy to rule out rare complications 4
- Recurrent inflammation at the scar site with episodic flares may indicate foreign body reaction, suture granuloma, or sterile abscess rather than normal healing 7
- Persistent pain or instability suggests surgical failure rather than scar-related issues and requires functional assessment 3, 6