2 November 2020
Dr. Federico Cipriani, plastic surgeon between Pisa and Bologna (Italy), talks about scars based on his experience.
All wounds due to traumas or surgeries result in scarring. Unfortunately, scars do not always have a pleasant appearance. They can often lead to functional and psychological problems, especially if located in some visible areas of the body —which can also have a negative psychosocial impact—.
Despite all the attention and care the surgeon may pay to the suturing of the wound, the healing also depends on the patient.
Scars become more evident and less pleasant from an aesthetic point of view when they tend to hypertrophy or —even worse still– when they turn into keloids. In this last case, the affected area becomes red, stiff, inelastic, itchy, and sometimes painful.
There are numerous factors that can predispose to “bad” healing. Among these, we find age: younger patients, in fact, on the one hand, are favoured by greater skin elasticity; yet, on the other, they tend to have more exuberant inflammatory and scarring processes.
Lifestyle habits also have an impact, as in the case of smoking patients: they are more likely to experience delayed scar healing or pain due to smoking —which affects their microcirculation at all levels—. Other frequent causes are comorbidities such as diabetes, immune-system diseases, nutritional deficiencies, and iatrogenic alterations —due, for example, to the use of certain drugs, such as immunosuppressants—.
WHAT STRATEGIES CAN IMPROVE THE QUALITY OF SCARS?
Medicine definitely follows the popular saying, “prevention is better than cure”. As a matter of fact, in many situations the best results are obtained with prevention.
I always suggest taking precautionary measures to avoid the onset of complications that can alter the healing process, such as the formation of haematomas, seromas, wound dehiscences or infections. Therefore, I educate patients on the importance —in the initial period— of avoiding physical efforts, not sweating to avoid the maceration of wounds, and following a local or systemic antibiotic therapy, when necessary. Finally, I use specific dressings depending on the type and location of the wound.
The final stage of the healing process can last up to a year. For this reason, after the healing is over, it is essential to inform the patient about how to improve the quality of the scar and minimize the risk of pathological scars.
It’s key to massage the affected area several times a day longitudinally and transversely using moisturizers, and to pinch the scar to detach it from the surrounding tissues, as well as to increase its elasticity and softness.
Afterwards, it is very important to apply silicone gels or patches, which —thanks to their mechanical compression function— are able in many cases to avoid scar hypertrophy.
The same concept applies when it comes to prescribing elastic-compression garments, when the healing process involves particularly large areas of the body.
Applying total photoprotection is also essential to avoid scar discolouration.
IS IT POSSIBLE TO IMPROVE OLD PATHOLOGICAL SCARS?
When prevention fails, medicine’s main goal is to cure or improve. In this case, in fact, to improve pathological scars —namely, hypertrophic scars or keloids— it’s possible to resort to invasive and/or conservative procedures.
Among these, we find the use of corticosteroids for intralesional injections, —which cause an involution of scar hypertrophy—, and the use of laser equipment. In the most severe cases and wherever more conservative medical therapies fail, surgery comes into play with the partial or total revision of the scar status. As Federico says, “Certain wounds need other wounds in order to properly heal.” Given the demonstrated high tendency of relapse, the recommendation is often to follow a combined approach of surgical techniques and medical treatments.