7 Tips For Scar Management

Autor: Michael Curtis

Source: http://www.michaelcurtispt.com/scar-management/

For some, a scar might be a symbol of pride – a battle wound, so to speak. For others, though, scars don’t rank high on their favorite physical features list. Most of us want to minimize the appearance of scars and the physical consequences that can accompany them – itching, stiffness, tenderness, and pain1,2.

Although scars can occur from wounds and burns, for our purposes here, let’s focus on how best to manage post-surgical scars.

What To Expect With a Post-Surgical Scar

Some surgeries are arthroscopic, leaving behind minimal scarring. Other procedures, such as a total knee replacement, or even a C-section, leave behind a larger, more obvious scar that may take some time to fully heal.

Yes, scars can take months, even years, to fully mature. If healing goes as it should, the scar should be linear and flush with skin, improving in appearance and pliability over time3.

An abnormal scar, however, might be raised and/or widespread. There are 2 types of abnormal scars to watch out for:

• Hypertrophic Scars: linear hypertrophic scars are raised but tend to stay within the confines of the initial incision4. They contain mostly well-organized Type III collagen5.

The good news is that it is possible for hypertrophic scars to spontaneously improve over time6,7.

• Keloid Scars: these are excessive scars that grow beyond the confines of the initial incision8. They contain disorganized Type I and II collagen bundles9.

Keloid scars don’t improve on their own and, even after being treated surgically, can recur10,11.

Although they can present differently, most current management strategies for both hypertrophic and keloid scars are similar.

Tips for Scar Management

Your first priority for scar management following surgery should be to prevent abnormal scar formation.

There are treatments that have proven to be effective for scar management such as laser therapy, corticosteroid injections, and even surgery, but these treatments must be performed by professionals and are invasive.

For effective scar management techniques you can perform on your own, here are 7 tips:

1. Silicone Scar Gel: Silicone Gel or sheeting is universally considered to be the gold standardand first line of defense and treatment for hypertrophic and keloid scars12. There are silicone gel products widely available over-the-counter.

These gels can help with itching as well as reduce the size of scars through occlusion and hydration. I would recommend using a gel as soon as the suture is healed13.

Silicone therapy should be continue for as long as necessary – if there continues to be an increase in scar size14.

2. Onion Extract-Based Gel (Mederma): Quercetin is found in onion extract – a main ingredient in the popular scar treatment Mederma – and has anti-inflammatory and anti-proliferative effects15.

Although Mederma is widely used for scar management, it is important to note that, based on two prominent studies I looked at, the only improvement noted with Mederma use was better collagen organization (a microscopic improvement). There wasn’t any significant benefit in scar appearance or symptoms when compared with no treatment or standard petrolatum ointments16,17.

3. Vitamin E: Vitamin E is believed to reduce the amount of reactive oxygen available during the inflammatory stage of healing.

There have been many case reports18 reporting better scar appearance when vitamin E is used during the healing process. Some studies, however, have found vitamin E to be of no benefit19,20

4. Limit Scar Stretching During Healing: keloid and hypertrophic scars usually occur in areas of the body frequently stretched during natural daily movements21.

To prevent abnormal scar formation, it would be ideal to avoid putting tension on the healing scar to allow it to heal normally.

Yes, this is easier said than done.

However, some methods that might help reduce skin tension and, therefore, promote healing, are tape22, bandages, garments, or silicone gel sheets (see above).

5. Compression: If you experience more widespread hypertrophic or keloid scarring, pressure garments can be worn.

Compression can decrease the production of collagen, decrease swelling, improve itchiness and pain23.

Make sure that the compression garment applies at least 15mm Hg, which is the minimum amount of pressure proven to promote scar maturation24.

Compression can be continued as long as there is abnormal thickening of the scar25.

6. Massage: massage therapy can disrupt fibrotic tissue and increase the pliability of the scar26,27. It can also improve swelling, thickening, and hardening of the scar tissue28.

Generally, it’s safe to start massage therapy 10 to 14 days after primary closure of the incision (talk to your surgeon to be sure). Make sure you don’t start massaging before this because it can actually have the opposite effect we want – there is evidence that mechanical pressure during early phases of wound healing can promote hypertrophic scar formation29.

Before you start to massage the scar, make sure you have clean hands and there’s no bleeding present.

Also, make sure you apply enough pressure to blanch the scar (make it white with pressure). But don’t apply too much pressure to damage the skin – use good judgment.

Use deep friction massage for 10 minutes twice per day, for up to 6 months. Friction massage is performed with the tip of your thumb or fingers in a transverse motion over the scar (like you’re strumming a guitar string).

Make sure to stop massage treatment if there is a break in the skin, excessive discomfort, or an infection.

7. Sunscreen: Be sure to keep your scar out of sunlight as much as possible until the scar has matured.

UV radiation has been shown to increase scar pigmentation, making its appearance worse30,31.

If you’re going to be out in the sun, use maximal sun protection >50 SPF32.

Rather than waiting until a scar becomes either hypertrophic or keloid, early treatment aimed at prevention is key.

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