Scar Management

Abstract

Scar tissue is the result of all wound healing processes. This has major implications for the patient, as scar tissue is usually less mechanically resistant, is aesthetically displeasing, and can cause functional impairment through contractures and itch. The extent of scar formation is mostly influenced by the duration and extent of the inflammatory phase of wound healing. Shortening the inflammatory phase can lead to healthier scar tissue. After wound healing, a number of early interventions have been shown in various studies to be beneficial for the development of normal mature scars, such as immobilization, different topical treatments, and compression. The best documented among the topical treatments is silicone as a gel or sheets. In case of hypertrophic scarring or keloid formation, the best evidence is available for intralesional treatments, classically intralesional corticosteroids. Newer intralesional treatments with slightly increased efficacy and less side effects include the intralesional application of 5-fluorouracil or bleomycin. Cryotherapy which can also be performed intralesionally sometimes provides a more effective option. All of these treatments, along with numerous other less documented treatments, have in common that they have varying results and usually need to be applied over long time periods. Surgical correction of disturbing scars should only be performed after scar maturation and in the case of keloids only in combination with other modalities such as intralesional injections or radiotherapy.