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Scar Management

What is a scar?

Following an injury or surgery the body attempts to repair the tissues that have been damaged or operated upon by laying down fibrous tissue.  When this fibrous tissue gets organised it forms a scar. 

What is the normal timescale for resolution of scars?

In the early stages following surgery the scar may be slightly red, raised, lumpy or itchy for a period of several weeks or months.  This is dependent upon the individual skin type of the patient and the location of the scar. 

Patients with Asian or Afro-Caribbean skin have a greater predilection for unfavourable scars which may be either hypertrophic or keloid. 

In addition there are certain areas of the body where scar formation is less predictable and may be unfavourable.  These are the pre-sternal area (in front of the breast bone), the deltoid area (the outer aspect of the upper arm) and the back. 

What is a hypertrophic or keloid scar?

The normal time course for resolution of scars is between six and twenty-four months at which time the scar is usually mature and becomes a faint line if it has healed well. 

However in certain situations (if the wound has opened up after surgery or has been infected) the scar may take some time to heal.  In this situation the scar may be raised, red, lumpy and itchy.  If such a scar resolves over a period of twelve to eighteen months it is more likely to be hypertrophic.  However if a scar grows beyond its original confines, continues to be painful and itchy and continues to grow beyond eighteen to twenty-four months following the injury or surgery it is more likely to be a keloid scar

What is the normal management for a scar? 

Scars which result from surgery and heal uneventfully are usually treated by moisturisation and massage to help them to mature.  Most patients benefit from the topical application of silicone gel cream or silicone gel sheets to hasten the process of scar maturation. 

You will be advised with regard to the timing and intensity of moisturisation and massage that you require and also the need or otherwise for the application of silicone gel when you see me following your surgery. 

How is a hypertrophic scar treated?

A hypertrophic scar is initially treated either with topical application of a silicone gel cream or sheet or by a combination of silicone gel and an injection of a steroid solution into the scar.  The steroid solution changes the metabolism of the scar and helps it to soften, to flatten and to become less red.  Most patients require a course of injections into the scar (two to six injections normally suffice) to see a significant improvement.  

How is a keloid scar treated?

The treatment of keloid scars is much more difficult as keloids are known to recur and spread beyond the confines of the original scar.

The first line of treatment of a keloid scar is similar to that of a hypertrophic scar. It consists of regular injections of steroid solution into the scar at intervals of two to four weeks until the keloid becomes soft, stops itching and is no longer painful. 

If the keloid is well localised and is not growing rapidly in certain areas of the body, such as the earlobe, it may be possible to excise the keloid intralesionally i.e. leaving a small rim of scar to prevent spread beyond the original confines.  Following this excision most patients require a single dose of superficial radiotherapy to the scar which has to be given within twenty-four hours of surgery.  This is arranged with the Radiotherapist before your surgery is carried out.  Following surgery and radiotherapy the scar has to be followed very closely at two weekly intervals and there may be a need for intralesional steroid injections at regular intervals to ensure that the keloid does not recur.

Despite all these precautions a keloid can recur in up to 30% of patients. 

Can I go out into bright sunlight or use a tanning machine following surgery?

Scars need to be protected from direct sunlight and ultraviolet radiation for a period of up to six months following surgery.  This is because the melanocytes in the scar can be stimulated by sunlight and ultraviolet radiation and can result in hyper-pigmentation (dark scars) which can be a permanent effect. 

It is advisable to use sunscreen with 50+ SPF and to use a hat with a brim if the scar is on the face for a period of six months following surgery.

I would like to say that my whole experience with Mr Sood and the Hartswood Hospital before and after my procedure was excellent. I felt safe and relaxed throughout.

Barbara S

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