Scar Revision: Combination Approaches Work Best

The body’s reaction to a surgical incision is completely understandable - scars are unavoidable.

Although scar tissue’s the same collagen as the tissue it replaces, its fibrous composition is different. Normal tissue has a basket weave of random collagen fiber, but scar collage fibers align in a single direction. Surgeons and patients usually do their best to prevent or reduce scarring, but sometimes scars may be unsightly or painful, and revision becomes necessary.

The May 2016 issue of Dermatologic Surgery included a supplement that addressed scarring. One section provided a treatment algorithm to help surgeons plan surgical scar revision with combination treatments.

The authors, a team of dermatologists from California and Colorado, expanded findings from a comprehensive literature search with their own personal experiences.

Assessment included examination of the scar’s tension, texture, and erythema — knowing scar texture in particular was critical when selecting treatments.

Since scars mature over the course of an entire year, the authors noted that surgical excision should occur only after that time. Other modalities can be used earlier, with laser therapy using vascular lasers (if erythema is present) the earliest recommended intervention.

These authors found publications describing surgical excision, intralesional corticosteroid injection, intralesional 5-fluorouracil injection, pulse dye laser treatment, nonablative fractional laser resurfacing, ablative fractional laser resurfacing, microneedling, and fractional needle radiofrequency. Each modality could be used alone or in combination with other approaches, and they identified their strengths and limitations, providing guidance as to what type of scar seemed to respond best.

Managing patient expectations was always important when delivering care, and scar revision was no exception. This article’s augmentation with clinical photographs helped the reader understand how much scar appearance could be expected to improve.

This article’s treatment algorithm covered many treatment options, and also explained how to combine them safely and effectively — using a rationale approach to scar revision would deliver the best possible results.