SCARS CAN BE UNPREDICTABLE

■When prevention doesn't work, treatment helps patients with scars


In Surgical wounds, traumatic wounds and burns to include chemical peels and laser skin resurfacing, a very important aspect of post-operative care is the prevention of infection.  Infection can be caused by bacteria such as Staphylococcus as well as viruses, such as Herpes.  If the patient is a carrier of the bacteria or virus, despite good surgical treatment, good post-operative hygeine, and antibiotics/anti-viral medication, infection can occur.  It is extremely important that the patient use good hygiene and anti-sepsis in the postoperative healing phases (that means good hand washing, keeping your bathroom and counter-tops cleaned with alcohol, clean bed sheets, avoiding pets, etc.).  Many of these infections caused by bacteria and virues can be difficult to treat and can advance despite good treatment. Infection can transform a superficial wound or burn that normally would not scar, into a full thickness injury of the skin that can scar. Sometimes, these scars can be thick and symptomatic (sensitive to touch and itching).  These thick scars are classified as  "Hypertrophic Scars" or "Keloid Scars". The "Hypertrophic Scar" is a scar that elevates above the surface, whereas a "Keloid Scar" not only elevates above the surface, but spreads out beyond the normal boundry of the initial wound.  If the scars occur around structures that are mobile (joints, eyelids, lips), the scars can pull and distort the tissues as they heal.

"Good surgical technique and infection prevention can stop surgical scars, but they often form despite the best methods, says plastic surgeon Kelly Gallego. Surgery, silicone dressings, pressure, corticosteroids, radiation, cryosurgery, lasers, vitamin E and other topical treatments can lessen the appearance of scars and prevent recurrence, he said. The choice of treatment depends on the patient and type of scar. Some patients with hypertrophic or keloid scars may be poor candidates for surgery because the risk of recurrence might be unacceptably high."