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Chirurgie 1. April 2012

Nonsurgical therapy for postoperative hypertrophic scars

BACKGROUND: Scars are the visible result of wound healing after injury or surgical procedures. The quality of scars is determined by a multitude of factors including the nature of the injury or surgical procedure, anatomic location and genetic disposition. Furthermore, scar formation is the result of a complex interaction of cells, growth factors, cytokines, components of the extracellular matrix and collagen metabolism. Pathological hypertrophic scars can lead not only to aesthetic and psychological but also to functional impairment and pain. METHODS: The relevant literature on nonsurgical therapy of hypertrophic scars was reviewed. RESULTS: According to publications with different levels of evidence, nonsurgical therapies for hypertrophic scars include compression therapy, silicone sheeting or topical application of silicone gels, injection of corticosteroids, and various laser and radiotherapies, alone or combined. CONCLUSIONS: The best option is not to have to treat hypertrophic scars, i.e. to prevent their development. If, however, a hypertrophic scar has developed, there are several treatment modalities. No single method achieves reliable and reproducible results in the treatment of hypertrophic scars and future studies will have to be directed at finding an optimal combination of treatments for each individual case. Our knowledge of scar biology progresses, and as more and more clinical trials are performed and new agents developed, further changes in the algorithms and better results can be expected.

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