Prevention of Post-surgical Scarring

Surgical scars can have significant physical and psychosocial effects on patients. Clinical trials have identified a limited number of interventions that are associated with proven reductions in scar size and improved appearance. Few pre-operative measures have proven benefits but may include managing patient stress levels, body warming, and possibly vitamin E application. Intra-operatively, good planning and prevention of blood loss and infection are essential; suture material and size may be less important. Although surgical denervation can hinder wound repair, perioperative botulinum neurotoxin injection around the surgical site is among the most useful interventions for improved scarring. Post-operatively, there is also good evidence to support the use of hypochlorous acid, silicone dressings and gels, and laser treatment. As the remodelling phase of healing can last for up to a year, some such interventions may need to continue well beyond the immediate perioperative period. Many other methods offer potential for post-operative benefit, including platelet-rich plasma, micro-needling, and various wound dressings and topical preparations. Further studies are required. In the future, approaches that redirect wound healing towards a more ‘foetal’ type of process might make truly scarless surgery a possibility.