Evidence-Based Scar Management: How to Improve Results with Technique and Technology

@article{Khansa2016EvidenceBasedSM,
  title={Evidence-Based Scar Management: How to Improve Results with Technique and Technology},
  author={Ibrahim Khansa and Bridget Harrison and Jeffrey E. Janis},
  journal={Plastic and Reconstructive Surgery},
  year={2016},
  volume={138},
  pages={165S–178S}
}
BACKGROUND Scars represent the visible sequelae of trauma, injury, burn, or surgery. [] Key Method Each intervention's effectiveness at preventing or reducing scars was rated as none, low, or high, depending on the strength of the evidence for that intervention. RESULTS For the prevention of hypertrophic scars, silicone, tension reduction, and wound edge eversion seem to have high efficacy, whereas onion extract, pulsed-dye laser, pressure garments, and scar massage have low efficacy. For the treatment of…
Current Therapeutic Approach to Hypertrophic Scars
TLDR
Current therapeutic approach and emerging therapeutic strategies for the management of HSs are reviewed, which should be individualized, based on an evaluation of the scar itself, patients’ expectations, and practical, evidence-based guidelines.
Scoping Review of Therapeutic Strategies for Keloids and Hypertrophic Scars
TLDR
Neither excision plus adjuvant therapy or nonsurgical treatments can be recommended preferentially at this time for keloid or hypertrophic scar treatments, based on qualitative review of recurrence.
The Efficacy and Safety of Botulinum Toxin Injections in Preventing Postoperative Scars and Improving Scar Quality: A Systematic Review and Meta-Analysis
TLDR
It is demonstrated that botulinum toxin injections can significantly improve cosmetic appearance and postoperative scar quality and are safe.
Summary and evidence grading of over-the-counter scar treatments.
TLDR
Online advertising may tempt patients to buy and trial products to help minimize scarring, although the evidence for the effectiveness of these products is absent to minimal.
Mitigation of Postsurgical Scars Using Lasers: A Review
TLDR
Treatment with lasers in the postsurgical wound healing phase is safe, effective, and advised in mitigation of pathologic scar formation.
A systematic review evaluating the influence of incisional Negative Pressure Wound Therapy on scarring
TLDR
Preclinical as well as clinical evidence indicates a beneficial influence of incisional Negative Pressure Wound Therapy on scarring, and moderate level evidence indicates that iNPWT decreases scar width and improves patient and observer‐reported scar satisfaction.
The Most Current Algorithms for the Treatment and Prevention of Hypertrophic Scars and Keloids: A 2020 Update of the Algorithms Published 10 Years Ago
  • R. Ogawa
  • Medicine
    Plastic and reconstructive surgery
  • 2021
Background: In 2010, this Journal published my comprehensive review of the literature on hypertrophic scars and keloids. In that article, I presented evidence-based algorithms for the prevention and
Keloids: A Review of Etiology, Prevention, and Treatment.
TLDR
Despite the growing literature investigating reliable methods for keloid management, there are no standardized guidelines or treatment protocols supported by academic governing bodies and stronger evidence with high-fidelity randomized clinical trials will be needed to determine the optimal therapy regimens.
Diagnosis and Treatment of Keloids and Hypertrophic Scars—Japan Scar Workshop Consensus Document 2018
TLDR
A tool that allows clinicians to objectively diagnose and distinguish between keloids, hypertrophic scars, and mature scars is created, and a Consensus Document on keloid and hypertrophic scar treatment guidelines are prepared, which will allow even inexperienced clinicians to choose the most appropriate treatment strategy.
...
...

References

SHOWING 1-10 OF 145 REFERENCES
Improving Scar Quality: A Prospective Clinical Study
TLDR
A comparative clinical prospective study evaluating scar quality following primary healing of elective surgical and traumatic facial wounds with prophylactic MEBO application, topical antibiotic ointment application, and no topical therapy at all.
Scar prevention and remodeling: a review of the medical, surgical, topical and light treatment approaches
TLDR
Overall, though topical modalities are easier to use and are usually more attractive to the patient, the surgical approaches still prove to be superior and more reliable and advances in topical medications for scar modification are on the rise and a change towards medical treatment of scars may emerge as the next best approach.
Prospective, Before-After Cohort Study to Assess the Efficacy of Laser Therapy on Hypertrophic Burn Scars
TLDR
Laser therapies significantly improve both the signs and symptoms of hypertrophic burn scars, as measured by objective and subjective instruments.
Fat Injection for Cases of Severe Burn Outcomes: A New Perspective of Scar Remodeling and Reduction
TLDR
Preliminary results show that lipofilling improves scar quality and suggest a tissue regeneration enhancing process, and shows considerable improvement in the mimic features, skin texture, and thickness.
Laser Therapy for Prevention and Treatment of Pathologic Excessive Scars
TLDR
This study presents the first meta-analysis to confirm the efficacy and safety of laser therapy in hypertrophic scar management, and indicates that the therapeutic effect of pulsed-dye laser therapy is better on patients with lower Fitzpatrick skin type scores.
A Randomized, Controlled Trial to Determine the Efficacy of Paper Tape in Preventing Hypertrophic Scar Formation in Surgical Incisions that Traverse Langer's Skin Tension Lines
TLDR
The development of hypertrophic and stretched scars in the treatment group only after the tape was removed suggests that tension acting on a scar is the trigger for hypertrophic scarring.
Pilot study evaluating topical onion extract as treatment for postsurgical scars.
  • B. Jackson, A. Shelton
  • Medicine
    Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]
  • 1999
BACKGROUND Post surgical scars can be erythematous, raised, pruritic and painful. Numerous modalities are available to improve the appearance and symptomatology of these scars. A topical onion gel
Effect of Mederma on hypertrophic scarring in the rabbit ear model.
TLDR
Despite the authors' inability to demonstrate a reduction in scar hypertrophy, the improvement in collagen organization noted in the Mederma-treated scars suggests it may have an effect on the pathophysiology of hypertrophic scar formation.
...
...