Semin Plast Surg 2016; 30(03): 122-128
DOI: 10.1055/s-0036-1584824
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Update on Postsurgical Scar Management

Sarah Jane Commander
1   Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
,
Edward Chamata
1   Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
,
Joshua Cox
1   Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
,
Ryan M. Dickey
1   Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
,
Edward I. Lee
1   Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
› Author Affiliations
Further Information

Publication History

Publication Date:
26 July 2016 (online)

Abstract

Postoperative scar appearance is often a significant concern among patients, with many seeking advice from their surgeons regarding scar minimization. Numerous products are available that claim to decrease postoperative scar formation and improve wound healing. These products attempt to create an ideal environment for wound healing by targeting the three phases of wound healing: inflammation, proliferation, and remodeling. With that said, preoperative interventions, such as lifestyle modifications and optimization of medical comorbidities, and intraoperative interventions, such as adherence to meticulous operative techniques, are equally important for ideal scarring. In this article, the authors review the available options in postoperative scar management, addressing the benefits of multimodal perioperative intervention. Although numerous treatments exist, no single modality has been proven superior over others. Therefore, each patient should receive a personalized treatment regimen to optimize scar management.

 
  • References

  • 1 Broughton II G, Janis JE, Attinger CE. The basic science of wound healing. Plast Reconstr Surg 2006; 117 (7, Suppl) 12S-34S
  • 2 Furie B, Furie BC. Mechanisms of thrombus formation. N Engl J Med 2008; 359 (9) 938-949
  • 3 Leibovich SJ, Ross R. The role of the macrophage in wound repair. A study with hydrocortisone and antimacrophage serum. Am J Pathol 1975; 78 (1) 71-100
  • 4 van Amerongen MJ, Harmsen MC, van Rooijen N, Petersen AH, van Luyn MJ. Macrophage depletion impairs wound healing and increases left ventricular remodeling after myocardial injury in mice. Am J Pathol 2007; 170 (3) 818-829
  • 5 Grotendorst GR, Soma Y, Takehara K, Charette M. EGF and TGF-alpha are potent chemoattractants for endothelial cells and EGF-like peptides are present at sites of tissue regeneration. J Cell Physiol 1989; 139 (3) 617-623
  • 6 Regan MC, Kirk SJ, Wasserkrug HL, Barbul A. The wound environment as a regulator of fibroblast phenotype. J Surg Res 1991; 50 (5) 442-448
  • 7 Field FK, Kerstein MD. Overview of wound healing in a moist environment. Am J Surg 1994; 167 (1A): 2S-6S
  • 8 Levenson SM, Geever EF, Crowley LV, Oates III JF, Berard CW, Rosen H. The healing of rat skin wounds. Ann Surg 1965; 161: 293-308
  • 9 Faintuch J, Matsuda M, Cruz ME , et al. Severe protein-calorie malnutrition after bariatric procedures. Obes Surg 2004; 14 (2) 175-181
  • 10 Gu Q, Wang D, Cui C, Gao Y, Xia G, Cui X. Effects of radiation on wound healing. J Environ Pathol Toxicol Oncol 1998; 17 (2) 117-123
  • 11 Tibbs MK. Wound healing following radiation therapy: a review. Radiother Oncol 1997; 42 (2) 99-106
  • 12 Chow LW, Loo WT, Yuen KY, Cheng C. The study of cytokine dynamics at the operation site after mastectomy. Wound Repair Regen 2003; 11 (5) 326-330
  • 13 Cohen IK, Diegelmann RF, Johnson ML. Effect of corticosteroids on collagen synthesis. Surgery 1977; 82 (1) 15-20
  • 14 Petry JJ. Surgically significant nutritional supplements. Plast Reconstr Surg 1996; 97 (1) 233-240
  • 15 Hom DB, Odland RM. Prognosis for facial scarring. In: Harahap M, ed. Surgical Techniques for Cutaneous Scar Revision. New York, NY: Marcel Dekker; 2000: 25-37
  • 16 Smack DP, Harrington AC, Dunn C , et al. Infection and allergy incidence in ambulatory surgery patients using white petrolatum vs bacitracin ointment. A randomized controlled trial. JAMA 1996; 276 (12) 972-977
  • 17 Trookman NS, Rizer RL, Weber T. Treatment of minor wounds from dermatologic procedures: a comparison of three topical wound care ointments using a laser wound model. J Am Acad Dermatol 2011; 64 (3, Suppl) S8-S15
  • 18 Baumann LS, Spencer J. The effects of topical vitamin E on the cosmetic appearance of scars. Dermatol Surg 1999; 25 (4) 311-315
  • 19 Chung VQ, Kelley L, Marra D, Jiang SB. Onion extract gel versus petrolatum emollient on new surgical scars: prospective double-blinded study. Dermatol Surg 2006; 32 (2) 193-197
  • 20 Gold MH, Foster TD, Adair MA, Burlison K, Lewis T. Prevention of hypertrophic scars and keloids by the prophylactic use of topical silicone gel sheets following a surgical procedure in an office setting. Dermatol Surg 2001; 27 (7) 641-644
  • 21 Atkinson JA, McKenna KT, Barnett AG, McGrath DJ, Rudd M. A randomized, controlled trial to determine the efficacy of paper tape in preventing hypertrophic scar formation in surgical incisions that traverse Langer's skin tension lines. Plast Reconstr Surg 2005; 116 (6) 1648-1656 , discussion 1657–1658
  • 22 Costa AM, Peyrol S, Pôrto LC, Comparin JP, Foyatier JL, Desmoulière A. Mechanical forces induce scar remodeling. Study in non-pressure-treated versus pressure-treated hypertrophic scars. Am J Pathol 1999; 155 (5) 1671-1679
  • 23 Kim EK, Hovsepian RV, Mathew P, Paul MD. Dermabrasion. Clin Plast Surg 2011; 38 (3) 391-395 , v–vi
  • 24 Smith JE. Dermabrasion. Facial Plast Surg 2014; 30 (1) 35-39
  • 25 Manuskiatti W, Fitzpatrick RE. Treatment response of keloidal and hypertrophic sternotomy scars: comparison among intralesional corticosteroid, 5-fluorouracil, and 585-nm flashlamp-pumped pulsed-dye laser treatments. Arch Dermatol 2002; 138 (9) 1149-1155
  • 26 Lyons RF, Abergel RP, White RA, Dwyer RM, Castel JC, Uitto J. Biostimulation of wound healing in vivo by a helium-neon laser. Ann Plast Surg 1987; 18 (1) 47-50
  • 27 Kana JS, Hutschenreiter G, Haina D, Waidelich W. Effect of low-power density laser radiation on healing of open skin wounds in rats. Arch Surg 1981; 116 (3) 293-296
  • 28 Allison KP, Kiernan MN, Waters RA, Clement RM. Pulsed dye laser treatment of burn scars. Alleviation or irritation?. Burns 2003; 29 (3) 207-213
  • 29 Blondeel PN, Richter D, Stoff A, Exner K, Jernbeck J, Ramakrishnan V. Evaluation of a new skin closure device in surgical incisions associated with breast procedures. Ann Plast Surg 2014; 73 (6) 631-637
  • 30 Banov D, Banov F, Bassani AS. Case series: the effectiveness of fatty acids from pracaxi oil in a topical silicone base for scar and wound therapy. Dermatol Ther (Heidelb) 2014; 4 (2) 259-269
  • 31 McCord SS, Levy ML. Practical guide to pediatric wound care. Semin Plast Surg 2006; 20: 192-199
  • 32 Younai S, Nichter LS, Wellisz T, Reinisch J, Nimni ME, Tuan TL. Modulation of collagen synthesis by transforming growth factor-beta in keloid and hypertrophic scar fibroblasts. Ann Plast Surg 1994; 33 (2) 148-151
  • 33 Chan KY, Lau CL, Adeeb SM, Somasundaram S, Nasir-Zahari M. A randomized, placebo-controlled, double-blind, prospective clinical trial of silicone gel in prevention of hypertrophic scar development in median sternotomy wound. Plast Reconstr Surg 2005; 116 (4) 1013-1020 , discussion 1021–1022
  • 34 Bettinger DA, Yager DR, Diegelmann RF, Cohen IK. The effect of TGF-beta on keloid fibroblast proliferation and collagen synthesis. Plast Reconstr Surg 1996; 98 (5) 827-833
  • 35 Mustoe TA, Cooter RD, Gold MH , et al; International Advisory Panel on Scar Management. International clinical recommendations on scar management. Plast Reconstr Surg 2002; 110 (2) 560-571
  • 36 Norris JE. Superficial x-ray therapy in keloid management: a retrospective study of 24 cases and literature review. Plast Reconstr Surg 1995; 95 (6) 1051-1055
  • 37 Jones K, Fuller CD, Luh JY , et al. Case report and summary of literature: giant perineal keloids treated with post-excisional radiotherapy. BMC Dermatol 2006; 6: 7