Scar tissue

To examine the place of surgery and other modes of treating scar tissue given the plethora of measures that are advocated on the internet.

There is good evidence to support the use of silicone sheets, pulsed dye laser (PDL), intralesional triamcinolone and dermabrasion in reducing hypertrophic scars, but each needs qualifying in terms of their timing and the type of scar tissue that they are used for.

The surgical revision of scars should be delayed for at least 12 months unless there is webbing when redistributing skin tension forces with a Z-plasty or multiple Z-plasties or other local flaps negates the need to wait for the scar to mature. In a posttraumatic 'horse shoe' shaped, or a very oblique, cut an irregular contour is likely to occur. Under these circumstances a triamcinolone injection into any raised area can help and this needs to be re-evaluated after 6 weeks. With a less irregular contour dermabrasion can help if used 8 weeks after surgery. With hypertrophic scarring both silicone gel sheeting and PDL may help reduce the prominence of the scar. Most of all time helps scars to settle and fade and typical scar maturation takes 18-24 months. The role of stem cells, particularly from adipose tissue, warrants further study.