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    Scar problems

    Scars are not only an aesthetic problem. Scars near the joints restrict mobility.

    In the vicinity of the eye, scars impair the closing of the eye or lead to a watering eye.

    In the area of the mouth, scars distort the facial expression.

    This creates a scar:

    The aim of a good skin suture is a tension-free, gentle and exact adaptation of the wound edges so that the wound heals as inconspicuously and quickly as possible. Therefore, wounds are ideally sutured with very fine threads and under optical magnification.

    1st week: During these days, scabs form.

    Week 2: Final scar tissue develops, the wound contracts.

    Week 3: The scar tissue begins to lighten and flatten slowly. The scar has reached 20% of its final firmness.

    Scar healing takes 6 to 12 months. In the first few months, scars are reddened, possibly painful or itchy and sometimes slightly raised above the skin level.

    As a rule, scars are pale, soft, painless and flat after one year.

    What can I contribute to favourable scar healing?

    • UV rays (sun or solarium) can lead to a permanent dark discoloration of the scar. Protect your scar with sun protection factor 50 or UV-impermeable clothing, especially in the first year.
    • The healing of wounds and scars is negatively influenced by the following factors: smoking, excessive exercise or germ colonisation.
    • In the third postoperative week, scar healing can be supported by massaging several times a day in a circle for a few minutes, as well as lengthwise and crosswise to the course of the scar with oily creams (e.g. Bepanthen® ointment or Linola® fat).
    • Silicone plasters prevent the formation of bulges and soften the scar (e.g. Cica-Care by Smith and Nephew or Medipatch Gel Z® by asclepios Medizintechnik e.K.). For this purpose, the silicone patch should be worn continuously for one year.
    • Compression treatment with special compression underwear also supports favourable scar healing. Compression underwear must also be worn continuously for the entire duration of the scar healing process, i.e. one year.

    How scars heal best

    Scars are not only an aesthetic problem, they can also restrict functionality.

    What is a keloid scar?

    Growing, itchy, reddish or dark scars are called scar growths. Scar growths are known as keloids. The main characteristic of a keloid is that it grows beyond the borders of the injured tissue after the wound has already been closed. Keloids occur preferentially on the ears, shoulders and upper chest.

    What’s a hypertrophic scar?

    Hypertrophic scars are thick raised scars that do not grow beyond the border of the scar. However, the healing phase lasts up to one year.

    What is a scar contracture?

    Injuries to the skin that lead to the loss of tissue, such as burns, can cause a firm and contracted scar. This is called contracture. For surgical treatment, removal of the contracture and covering of the defect with a skin flap plastic or a graft is necessary.

    Which procedures do we offer for scar correction?

    • Surgical scar correction
    • Z-plastics
    • W- plastics
    • Injection of scars with autologous fat
    • Microneedling against scars
    • Injection of scars with cortisone

    The result of the scar correction depends on the type, size and course as well as on the individual wound healing, postoperative protection and scar care.

    What is the difference between keloids and hypertrophic scars?

    Beaded scar (hypertrophic scar)Sprawling scar (keloid)
    AppearanceSublime, limited to the woundProliferating beyond the wound edges
    Healing tendencyregressingNo regression tendency
    Scarring siteNo predilection sitesPredominantly on ears, sternum
    Healing processSpontane regressionNo regression
    Family tendencyNo risk of recurrenceHigh risk of recurrence
    Scar ShrinkagePossible ContractureNo Contracture
    Treatment methodsexcision, cortisone infiltration, printing, siliconeexcision, cortisone infiltration, printing, silicone, irradiation, 5-fluorouracil

    Which treatment methods do we offer for keloids?

    The selection of the right treatment together with you is the decisive step to success. We carry out the following treatments frequently and with good experience:

    • Removal of the keloid
    • Injection of keloid with cortisone
    • Injection of keloid with 5-fluorouracil

    Because keloids occur again and again, combined procedures such as surgical removal with injection or radiation are very advantageous. Pressure dressings with silicone foils delay the recurrence.

    Scar correction

    Since up to one year after wound closure the scars spontaneously become paler, flatter, softer and the pain less, surgical scar corrections should not be carried out earlier. In the case of medical indications, e.g. functional limitations, the treatment costs are usually covered by the health insurance.

    Author’s statement

    Author: Stéphane Stahl, MD, PhD. There are no financial relationships with the pharmaceutical or medical device industries that could have influenced the above text. Any reproduction, even partial, is permitted for personal use only. All texts used on this website are protected by copyright.

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