Treatment of Scarring After Surgery

Introduction:

Post-surgical scars are a matter of concern among individuals. There are many products available that might help with the post-operative formation of scars and improve wound healing. Such products create an ideal environment for the process of wound healing, like inflammation, proliferation, and remodeling. Along with this, certain lifestyle modifications, and interventions during operation like using precise operative techniques are important for obtaining a perfect scar. Treatment for optimizing scar formation should be personalized for each patient for better results.

What Is a Scar?

Scars are the body's natural way of healing and replacing damaged skin. It is made up of fibrous tissues. Most scars are permanent but may fade over a period of a few years, depending on the severity of the injury, type of injury, age, wound size, and wound location. Scars can appear anywhere in the body, and their shape varies from flat to lumpy. They can be itchy or painful. Certain individuals are prone to develop severe scars depending on factors like age, hereditary, and race.

How Is Scarring Treated?

Management of scarring commences before the surgery by chalking out a meticulous plan for better scar formation.

1. Before Surgery:

The effective treatment of post-operative scar formation starts before the surgical procedure. It includes proper management of underlying comorbidities that may hamper wound healing. For this, an extensive physical and medical examination is carried out to diagnose and treat any underlying medical conditions.

Certain parameters like pre-albumin and albumin can throw light on the nutritional status of the individual. Nutrients like fatty acids, amino acids, vitamins like C, E, and K, copper, zinc, and iron play a significant role in wound healing, and a deficiency in either one or all of these can lead to poor results. Improper blood circulation can lead to a slow re-epithelization and reduced tensile strength of the wound.

Several diseases such as diabetes mellitus have an impact on wound healing by reducing inflammation post-injury thus slowing the process of re-epithelization. Evaluating the blood glucose levels pre-surgery can be effective in identifying and treating the condition to improve the management of scar post-surgery.

Certain drugs such as corticosteroids can increase or reduce the capability of the body to heal. These medications decrease inflammatory response to injury thus slowing wound contraction, and increasing the chances of infection. Corticosteroids if taken for a long period can lead to skin thinning, and an increased chance of a skin tear. Thus the sutures do not hold the skin properly leading to improper wound healing.

Other factors such as cigarette smoking containing toxins like nicotine, carbon monoxide, and hydrogen cyanide impair wound healing. One should stop smoking a month before pre and post-surgery to obtain favorable scars.

2. During Surgery:

During surgery, a precise incision is directly associated with a good result along with re-epithelization of the skin. Incisions are given parallel or along the length of skin tension lines may help in obtaining positive outcomes. Meticulously planned surgical techniques such as proper handling of the skin, incision closure with less tension, and eversion of the skin on closure should be kept in mind while performing the surgery. Hemostasis (process to stop bleeding) is very important to reduce the formation of a hematoma (swelling of the tissues due to a blood clot), or seroma (fluid accumulation under the skin). As these can hinder the wound healing process causing fibrosis and deformed scar tissue.

3. After Surgery:

Post-surgery, emphasis should be given to proper wound healing by preventing the development of any infection.

4. Ointments-

Scar formation needs moisture. Applying antibacterial ointments or creams as advised by the physician plays a very important role in the formation of a scar by providing enough moisture. Triple antibiotic ointment should be applied after wound closure and continued for a few weeks. To minimize any allergic reaction to the ointments, one must switch to petroleum jelly for the next weeks.

Other ointments including vitamin D, E, and cocoa butter are also recommended for use for a good outcome. However, certain studies have not shown any improvement in scar formation with the use of these products as compared to petroleum-based ointments. These products provide a moisturized environment for the formation of an aesthetic scar. Maintaining appropriate moisture after wound healing is required for re-epithelization. Individuals experience reduced pain at the site of the incision.

• Sunscreen - It is important to protect the scar from sunlight for it can lead to hyperpigmentation and alterations in the collagen tissues, thus leading to a thick, dark scar. Applying proper sunscreen and covering the area while out in the sun is recommended for a year at least. Sunscreens tend to reduce hyperpigmentation of the scar.

• Massaging - Massaging the scar is recommended after it has healed. Massaging should begin only after the wound has healed completely. Ideally, scar massaging should begin after three weeks of surgery. The massaging should not injure the formed scar. Petroleum jelly or a lubricating moisturizer should be used to massage the scar in circular motions.

• Silicone Gel Sheet - It is a moisture-protective dressing used over the scar to keep it moist thus enhancing re-epithelization. These are mostly used for treating hypertrophic scars. They should be used for a period of three to four months not exceeding six months.

• Paper Tapes - Latex-free tapes such as paper tapes are placed over the incisions after surgery. These prevent the wound from stretching. They also keep the area moist thus promoting wound healing and decreasing the scar volume. Paper tapes should be placed for a period of six weeks.

• Pressure Dressings - Pressure dressings also help in scar management by flattening the scars and preventing their hypertrophy. Pressure dressings have been found to manage keloids very well.

• Dermabrasion - It is a method of using an abrasive to level the surface of the scar. The process involves removing some thicknesses of the skin. It can be performed after the wound is epithelized. However, it may cause skin bleeding which takes longer to recover.

• Steroids - Corticosteroid injections cannot reduce but improve the appearance of scars. The injections are given at intervals of four to six weeks.

• Cryotherapy - Liquid nitrogen is used in cryotherapy. It is used to freeze the keloid thus stopping its growth.

• Skin Needling - This procedure involves the use of a small device with numerous tiny needles that are rolled over the skin. It can help improve the appearance of the scars.

• Lasers - Low-energy lasers stimulate cellular activity leading to wound epithelialization. Helium-neon lasers and infrared lasers are quite beneficial to wound healing. Pulsed dye lasers lead to reduced itching and a decrease in scar thickness.

• Scar Revision Surgery - Scar revision surgery is carried out to minimize the scar so that it blends with the surrounding skin. A scar takes around a year or so to mature. Scar revision surgery changes the appearance of the scar.

Conclusion:

The formation of a scar is the body's natural process of wound healing. Although permanent, the scars can fade over time. There are numerous scar management procedures that are carried out to make the scars aesthetically pleasing. The standard scar management includes the application of petroleum jelly, and antibacterial ointments, to keep the area moist, keeping the area clean by frequent changing of the bandages, avoiding scab picking, and applying sunscreen to reduce sun exposure. However, no single treatment strategy is considered a definitive scar treatment as the treatment varies from individual to individual. The plan of scar management begins before surgery and is carefully carried out post-surgery.