For Surgeons

Overseas Information

Breakthrough in Scar Management

At the outset let me disclose that I have been involved in the research and development of this scar management product. Without a product promotional agenda, I would like to share with you sound principles and some unique concepts that we have successfully used in this product’s development.

For generations Plastic Surgeons have sought ancillary techniques for improving scar outcome. Fortunately for patients, other surgical specialties have also started to take note of advances in scar management. With progress in technology and surgical technique, standard operations have similar outcomes. However, public opinion will favour the surgeon who produces the better scar. Often the only perceptible evidence of the previous surgery is the remaining scar. Every effort should be made to produce an aesthetically acceptable scar free of symptoms. All wounds heal by scar formation – this scar will never disappear. However, a good scar is one that is thin, flat and approximates the colour of the surrounding skin rather than one that is stretched, thickened, irritable with a different colour from the surrounding skin.

As the complex series of events surrounding wound healing are more clearly understood, methods of improving scar outcome have evolved. The past 3 years has seen intensive local research culminating in the development of a product that appears to be unique in its concept and composition. Based on literature surveys, research studies and clinical information spanning 30 years, 3 areas have been identified as critical to attaining satisfactory scar outcome. Briefly, these are:

SUPPORT

It has been well documented that forces generated on a wound promote scar tissue. The vector of direction of these forces is important. Thus, normally a scar on the abdomen is subjected just to the rhythmical forces of breathing. These forces are generated in one direction (uni-directional) promoting a stretched spread scar. This contrasts with a presternal scar that is subject to multidirectional forces applied to it from movements of the arms, neck, shoulders, breasts etc. often resulting in a thickened hypertrophic scar.

All these changes relate to the effect tension has on collagen. If there is little tension across a scar, the mechanically weak collagen bond withstands the forces on it, a narrow scar results and the scar collagen remains aligned along the scar. If however, tension across the scar is sufficient to overcome the bond when sutures are removed, the longitudinal fibres separate and new collagen is laid down haphazardly across the scar. Tension is controlled by scar support. The most reliable method of scar support, proven both clinically and in documented trials, is by microporous tape placed on the surface of the scar in its longitudinal direction.

HYDRATION

The past few years have seen a plethora of articles investigating the positive effects of silicone sheeting, gels, Vitamin E and comparable agents on scars. The common positive factor to all these agents has been convincingly demonstrated in a number of scientific publications, to be hydration of the scar surface. It appears that hydration reduces water loss and restores homeostasis to the scar. Trials with silicone sheeting have shown comparatively good results when the silicone component of the dressing was replaced with water.

The Vitamin E “myth” (Medical Chronicle April 1998) has been perpetuated for generations as a 'miracle' scar management agent. The only positive effect proven in the laboratory is on the basis of hydration. On the negative side, the collagenase effect and documented reduced breaking strength of Vitamin E can result in excess spreading of the scar and even separation of the wound if used very early. Multiple cases of significant dermatitis have also been documented.

ACCELERATED SCAR MATURITY

A pink scar, in its reactive phase, is vulnerable to hypertrophic.

31 October 2002
Acknowledgements:
Prof Alan D Widgerow