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| PHYSICIAN'S PAGE |
| Management
of Scars By Bruce Smith, M.D., FACS |
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| Injuries
that penetrate the thickest layer of the skin often result in the formation of scar
tissue. Scars may follow a normal course of maturation and resolve to an acceptable state,
or they can become abnormal. Any delay in healing may predispose a person to abnormal scar
formation. Hypertrophic or keloid scars are considered abnormal. Hypertrophic scars are raised, thick scars that do not extend beyond the border of the scar. Keloid scars invade into adjacent normal tissue with increased color, thickness and height. These scars are disfiguring and can lead to a decrease in function, especialy if the joints are involved. The aim of therapy is to soften, flatten, smooth out the scar and normalize the color of the scar. Hypertrophic scars usually occur within the first six to eight weeks after the skin heals from an injury such as a burn or surgical incision. The scar continues to change or remodel over the next one or two years. Hypertrophic scars are more common when healing is delayed. The exact cause of this abnormal scarring is unknown. Keloid and Hypertrophic scars continue to be a widespread problem in particular for adult and child survivors of burns and individuals with darkly pigmentened skin. Dermatologists and other cosmetic surgeons have an array of treatment options for improving the clinical appearance of hypertrophic and keloid scars. Recently, silicone gel sheeting has been found to prevent and improve these scars. Silicon gel sheets are thought to work by hydrating the scar tissue. Rehydration softens the scar, thereby making it more flexible and improving the natural repair and flattening process. Other management techniques include further surgery, which may be self-defeating, especially when scarring results from previous surgical intervention. Pressure garments and the use of locally injected steroids (cortisone), surgical removal, radiation, emolients and massage, laser or cryotherapy therapy may also be used. Silicon gel sheets are becoming the first line of management for hypertrophic and keloid scars because the therapy is relatively inexpensive and easy to use. New and long standing scars can be treated with silicone gel sheets. Silicon gel sheets are generally well tolerated and local skin irritation rarely occurs. Mepiform with Safetec technology is a thin, flexible, self-adherent silicon dressing. This dressing can be applied, removed and reapplied to the scar area for comfortable scar care. It is used for the prevention and treatment of newly or previously developed hypertrophic and keloid scars. The consistent use of Mepiform will improve the scar’s appearance over time. Because of the dressing’s high breathability, Mepiform helps prevent moisture buildup under the dressing so it can be worn longer while avoiding uncomfortable itchiness. The dressing is flexible, discreet and features a very low profile; therefore, it is easy to wear under clothing. Mepiform is waterproof and can be worn while bathing, showering or swimming. It can also be easily cut to fit almost any area of the body. Bruce Smith, M.D., FACS is a board certified plastic surgeon at St. Joseph’s Hospital in Houston, TX. |
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