Patients with conspicuous, symptomatic or large unsightly scars may seek scar revision whether or not there is an associated function difficulty such as joint contracture. Symptoms may include itch or sometimes frank pain and hypersensitivity.
Conservative treatment options include regular massage of the scar with a bland moisturising cream. Contrary to popular opinion none has been shown to be better than any other. For scars that are red, raised and itchy, the application of a topical silicone preparation can be very effective in reducing the signs and symptoms associated with the scar. Both these treatments may take several months to have a significant effect. Silicone is available in solid sheets for use on the trunk and limbs and should be applied 24/7. For the face however, there is a more inconspicuous liquid preparation that should be applied twice daily as a coat and NOT rubbed into to the scar. There is little evidence for the use of pressure garments in scar management and this practice has largely been discontinued.
Hypertrophic scars are raised, red and itchy and are by definition, confined to the dimensions of the original scar. They tend to respond to treatment and improve spontaneously over time. Keloid scars on the other hand, appear later, grow outwith the original scar dimensions and can be very difficult to manage successfully. Such scars tend to occur in certain area of the body including the shoulders, ears and pre-sternum and are more common in fair skinned and black skinned people respectively. Steroid can be injected into hypertrophic and keloid scars on up to three or four occasions, normally 6-8 weeks apart.
Fine, mature scars that remain red can sometimes be improved with LASER treatments, see Laser Treatments – RefHelp
Surgical scar revision may be appropriate in some cases where the scar is over 18 months old and is still symptomatic or unsatisfactory in appearance. Various techniques are employed including Z- and W-plasties, serial excision and resurfacing with dermal substitutes and skin grafts.
M.A. & E.M-P. 11-12-24
Who to refer:
- Patients with scars that are a significant cosmetic or functional problem for the patient.
- Unsatisfactory post-operative scars should be referred back to the primary surgeon in the first instance.
Who not to refer:
- Patients with scars that are of cosmetic concern only, should be referred primarily via the EARP, Aesthetic Surgery – RefHelp
- Patients with immature scars should first undertake the appropriate conservative measures to improve scar quality (see information section above)
How to refer:
Via the SCI gateway to the Scar clinic at the Plastic Surgery service at St John’s Hospital or the Royal Hospital for Sick Children with appropriate details and background information.
