Early scar-directed interventions for thyroidectomy scars: a systematic review and network meta-analysis

Visible anterior neck scars after thyroidectomy and related cervicotomy procedures remain clinically important aesthetic and psychosocial concerns. This systematic review and network meta-analysis compared randomized evidence for early scar-directed interventions, while separating surgical closure method trials from postoperative scar modulation strategies. PubMed/MEDLINE, Embase, and Cochrane CENTRAL were searched independently from database inception to 17 June 2026. The primary outcome was scar quality at the longest available 3- to 12-month follow-up, assessed using POSAS, OSAS/PSAS, VSS/mVSS, SBSES, and MSS in a prespecified hierarchy. The primary connected network included six randomized trials comprising 408 unique participants and 469 analyzed scar/incision observations, with 10 direct comparisons and eight scar-directed treatment nodes. Laser plus steroid demonstrated a favorable low-certainty network estimate (standardized mean difference (SMD) -1.35, 95% CI -1.87 to -0.83), as did laser/light-based protocols (SMD -0.95, 95% CI -1.40 to -0.50). Platelet-rich plasma also showed a favorable estimate (SMD -0.95, 95% CI -1.73 to -0.16), but this evidence was very uncertain because the node was supported by a single small study with methodological concerns. CINeMA certainty was low or very low across comparisons. Closure method trials were retained as a descriptive evidence map because their mechanisms, timing, and clinical decision context differed from scar-directed therapy. These findings should be interpreted as hypothesis-generating and do not support definitive comparative superiority claims.

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420261427171, PROSPERO CRD420261427171.