Surgical Scars

Nobody leaves this world without a scar, without a scar on the skin.

All patients undergoing surgery with an incision on the skin will end up with a scar.  There is no such thing as scarless incision.

Scar Formation

A skin scar forms after a wound on the skin is caused by trauma or created by the surgeon. Skin scar is a form of wound healing.

There are three outcomes of wound healing after surgery with a linear skin incision:

  • Normal scar formation – a linear scar that is flat and pale in color or almost blending with the surrounding skin.
  • Hypertrophic scar – a scar raised above the skin level that stays within the confines of the original wound.
  • Keloid – a scar raised above skin level that proliferates beyond the confines of the original wound.

Normal Scar Formation – flat and pale in color scar

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Hypertrophic scar on some segment of the scar (left side of the picture)

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Keloid on the upper chest; hypertrophic or beginning keloid on the lower scar.

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What factors affect the outcome of wound healing, whether there will be a normal scar formation, hypertrophic scar, or keloid?

  • Genetic
  • Status of the wound at the time of wounding or surgery such as whether it was a dirty wound, linear, ruggedly lacerated, or big gaping wound, etc.
  • How the wound was treated by the physician or surgeon

The physician or surgeon can only do so much in promoting a normal scar formation such as:

  • Close wound by primary intention if possible
  • Close wound without tension
  • Close wound with proper apposition of skin edges
  • Use of proper sutures
  • etc.

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To use or not to use topical scar reduction medication after surgery:

Determine the risk for hypertrophic scars and keloid

High risk – past history of hypertrophic scars and keloids; location of the wound if in areas where hypertrophic scars and keloid is frequent

If high risk – try topical scar reduction medication after wound is covered completely with skin, usually after 2 months.

If not high risk – observe wound. At the first sign of hypertrophic scarring, try topical scar reduction medication.

The topical scar reduction medication that can be used are the following:

  • Hiruscar gel
  • Hirudoid cream
  • Contractubex gel
  • Dermatix Ultra gel
  • Silicone gel sheet

At the moment, there is no good research that shows superiority of one medication over the other.  (will do a research on this)

Cebo de Macho is popular in the Philippines. However, there are no research on its true effectiveness.

ROJ@15sept11

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