When Is Scar Surgery Necessary?
Scars tell stories of injuries, surgeries, and healing, but sometimes they become more than just a visual reminder. For certain individuals, scars can cause physical discomfort, restrict movement, or lead to emotional distress. While many scars can be managed with non-invasive or minimally invasive treatments, there are instances when surgical intervention becomes the best option. This blog explores when scar surgery is necessary, what it entails, and the factors to consider before opting for this step.
Scar Surgery as a Last Resort
Surgical scar revision is often viewed as a specialised, last-resort treatment within the hierarchy of scar management. Advances in treatment modalities, including silicone products, pressure therapy, laser and other energy-based devices, as well as the infiltration of steroids or other medications, have enhanced the effectiveness of non-invasive methods for scar management. However, despite these advancements, certain scars may still necessitate surgical intervention to improve function and appearance.
1. Functional Impairment Due to Scarring
Scars can go beyond being a cosmetic concern and significantly impact functions of daily living and with that quality of life.
Impact on Movement on Daily Life
Tightness: Generalised tightness from scarring can reduce flexibility and comfort, affecting overall mobility and daily comfort.
Joint Contractures: Burn scars or deep wounds often result in tight bands of tissue that significantly limit joint mobility. This restriction can impede essential activities such as holding a cup of tea, brushing hair, or bending, and may also affect overall posture.
Critical Areas: Scarring in sensitive areas (for example around eyes, mouth or genitals) can impair critical functions.
Surgical Goals
The primary aim of scar surgery in these cases is to restore functionality. For example, releasing a contracture can help a patient regain mobility and independence.
2. Significant Keloids or Hypertrophic Scars
Hypertrophic scars and keloids, although often resistant, usually undergo non-surgical management initially. However, some scars may persist with problematic features.
Characteristics of Problematic Scars
Hypertrophic Scars: These are elevated scars confined to the original wound area.
Keloids: These are thick, raised scars that extend beyond the initial wound limits and may progressively enlarge.
When Surgery Is Necessary
Surgery may become necessary if non-invasive treatments—such as silicone, pressure therapy, infiltration of steroids or other medications, as well as laser or other energy-based interventions—fail to significantly improve the scar's appearance or alleviate associated symptoms. Indications for surgery include persistent discomfort or the limitation of normal activities due to the scar.
Surgical Approaches:
Contracture Release and Tissue Rearrangement: Utilising local tissue rearrangement or, in some cases, grafts, dermal templates, and other techniques to cover defects.
Excision: Sometimes necessary, followed by primary closure or covering the defect with a variety of approaches.
Surgical Goal and Consensus:
Goal: Achieve the best functional outcome with minimal surgical intervention.
Consensus: Aligns with the general surgical principle of prioritising conservative measures whenever feasible.
3. Extensive or Complex Scars
Certain scars, due to their extensive size, depth, or challenging locations, necessitate surgical intervention for optimal outcomes.
Examples of Complex Scars:
Burn Scars: These often cover large areas and can result in contractures that significantly restrict movement.
Trauma Scars: Irregular and deep scars from accidents that may require reconstructive procedures for restoration.
Aesthetic Scars: Located in highly visible areas, these scars can cause significant emotional distress, though they often respond well to non-invasive therapies.
Surgical Considerations:
Addressing these scars typically involves a combination of techniques such as release, dermabrasion/shaving or excision and reconstructive procedures to achieve both functional and aesthetic improvements.
Factors to Consider Before Opting for Scar Surgery
Surgical intervention is not universally suitable for every patient or scar.
Patient Suitability:
Overall Health: Conditions such as diabetes or immune deficiencies can complicate post-surgical healing. Individual circumstances and lifestyle can also influence recovery times.
Age and Healing Capacity: Generally, younger individuals heal more rapidly, while older patients may face slower recovery times.
Scar Type and Location:
Recurrence Risk: Certain scars, like keloids, are prone to recurrence, particularly after surgical excision, sometimes even with adjunct therapies.
Location: The scar’s location can influence both the complexity of the surgery and the likelihood of a successful outcome.
Expected Outcomes:
Setting realistic expectations is crucial; while surgery can improve the appearance and functionality of scars, it is never possible for scars to be completely eliminated.
Post-Surgical Care:
A commitment to rigorous follow-up care is essential. Adjunct treatments such as silicone sheets, corticosteroids, and laser therapy play a crucial role in optimising results and minimising recurrence.
Alternatives to Surgery and When to Consider Them First
Exploring non-invasive and minimally invasive options is always recommended before considering surgery.
Non-Surgical Options:
Silicone and Pressure Garments: Products such as silicone sheets help hydrate the scar tissue, improving its appearance.
Steroid Infiltrations and Other Medications: Aim to reduce inflammation and decrease scar thickness.
Laser Therapies: Enhance scar color and texture by stimulating scar remodeling.
Combination Treatments:
Multimodal approaches can often significantly improve scars without the need for surgical intervention.
When Surgery May Be Indicated:
Surgical options can be considered after non-invasive methods have been thoroughly explored and/or have failed to yield satisfactory results.
Conclusion:
Scar surgery is a specialised intervention reserved for cases where scars significantly impair function, cause persistent symptoms, or lead to considerable cosmetic concerns. While non-invasive treatments are typically the first line of management, surgical intervention may offer transformative outcomes for patients with severe or complex scars.
Key Takeaways:
Surgery is typically reserved for situations where conservative management may not achieve the desired outcomes.
A personalised treatment plan is essential to address the unique needs of each scar and patient.
Follow-up care is crucial for achieving the best possible outcomes.