Essential Steps In Preventing And Managing Surgical Scars

Surgical scarring can leave a significant aesthetic impact on the patient. When a patient presents with a painful condition and has surgery, he or she is rarely thinking of the scar. However, for some patients, an unsightly scar can be just as disappointing as the prior condition.

It is important to address the expected type of surgical scar in the preoperative discussion. When reviewing the risks and complications of surgery, one should acknowledge the potential risk of scar-related complications. A careful examination of other scars along the patient’s body is a good indication of how the skin will heal overall.  

Bunion surgery is one particular area in which patients are not only looking for a functional improvement but a cosmetic improvement as well. With new minimally-invasive surgical techniques and, my favorite, the medial approach to hide the scar, the risk of visual scar dissatisfaction is decreased. Traditional bunionectomies can cause unsightly scarring that can take up to two years to completely resolve and remodel.

Evaluating Preventative And Therapeutic Approaches To Scars

Knowing a scar can take two years to finish realigning and remodeling collagen tissue, there are ways that we can expedite skin healing and provide faster improvement of the aesthetics to the foot. In addition to the negative effects of a hypertrophic scar, a dehisced incision or a keloid can delay the healing process and cause further complications. A way to minimize this risk is by using non-reactive suture material. Another way is to use a removable suture such as a subcuticular stitch with Monocryl^® suture (poliglecaprone 25, Johnson & Johnson).

Postoperatively, one of the most common ways to help expedite improvement of a scar is to perform laser resurfacing. Through a gradual warming and manipulation process to the skin, the scar collagen fibers go from a disorganized pattern to a more organized orientation that can decrease healing times by a year. 

Most lasers can assist in improvement of the scar. Many practices have lasers for onychomycosis and with certain settings on some of these lasers, one can adapt them for use on the scar itself. I use a Nd:YAG laser and start the treatment three weeks postoperatively. Patients receive four treatments total spaced four to five days apart. I recommend patients use a home regimen of silicone scar sheets to assist in post-treatment remodeling as well.

Dr. Schoenhaus is a Diplomate of the American Board of Foot and Ankle Surgery. She is in private practice in Boca Raton and Boynton Beach, Fla. One can follow Dr. Schoenhaus online at @jsfootdoc and www.bocaratonfootcare.com.