A Plastic Surgery Primer for the Treatment of Wounds and Scars

Scars and their minimization are common areas of interest for anyone who has ever been wounded. The options are many when over-the-counter remedies, non-surgical and surgical options are taken into account.

Marketing hype has distorted the truth in the name of selling a multitude of products and procedures. Despite the advertising copy, the use of most over-the-counter products on many scars will have little or no effect. In truth, scar improvement is more possible using some of these techniques rather than others dependent upon a number of factors.

Pivotal in the consideration for treatment of a wound or scar is the time from wounding. Early on after wounding (when the wound is open) proper wound care can minimize the later development of a poor or noticeable scar. An open wound should be properly cleaned and dressed to minimize the possibility of infection which usually has a negative impact upon a good mild scarring outcome.

Wounds that are not simple and clean frequently benefit from professional input to guide wound care and evaluate for closure or additional assistance. Wide openings or any more than mild contamination (for example dirt or grease within the wound) more often than not benefit from more than at home “do it yourself” care. Even if the wound is not to be professionally cleansed and/or closed, at the very least an antibiotic ointment such as Bacitracin or double or triple antibiotic ointment should be applied frequently. This keeps the wound moist and assists the body’s process until early healing has occurred. If the wound does not heal within a short period of time (days to weeks) with wound care or becomes more painful, bleeds or drains more, it is proper to consider professional help once again.

After a wound has healed and closed and scabs (if ever present) have resolved, consideration for scar improvement treatments can begin. Generally surgical improvement is not a good idea until scar maturation has occurred except in very rare circumstances. In the first months after initial healing while this maturation is underway, over-the-counter scar improvement products such as silicone sheeting might be helpful. Maturing scars should be protected from sunlight. Once scabs have resolved sunscreen and cover to protect from the pigment changes sunlight can cause are generally helpful.

When the scar has matured (generally months to a year) consideration for plastic surgery can begin. Scars soften and usually become less visible once mature. Scar Revision surgery is removal of the old scar and plastic surgical closure to minimize the formation of another scar. This is more reasonable when the space between the normal and scarred tissue is wider than roughly 5 mm or if the scar pattern is complicated or easily noticed. Laser therapies and other treatments are less standard and may or may not benefit the average scar. Proven studies of advantage from laser-mediated scar treatments are few and far between.

Please note the foregoing is general information that is not meant to cure or treat disease in the place of proper medical treatment. In the case in which a wound or scar is anything but the most simple, proper medical evaluation is recommended. This article is not meant to substitute for that professional treatment.