Summary
BACKGROUND: Scars are the visible result of wound healing after injury or surgical procedures. The quality of scars is determined by a multitude of factors including the nature of the injury or surgical procedure, anatomic location and genetic disposition. Furthermore, scar formation is the result of a complex interaction of cells, growth factors, cytokines, components of the extracellular matrix and collagen metabolism. Pathological hypertrophic scars can lead not only to aesthetic and psychological but also to functional impairment and pain. METHODS: The relevant literature on nonsurgical therapy of hypertrophic scars was reviewed. RESULTS: According to publications with different levels of evidence, nonsurgical therapies for hypertrophic scars include compression therapy, silicone sheeting or topical application of silicone gels, injection of corticosteroids, and various laser and radiotherapies, alone or combined. CONCLUSIONS: The best option is not to have to treat hypertrophic scars, i.e. to prevent their development. If, however, a hypertrophic scar has developed, there are several treatment modalities. No single method achieves reliable and reproducible results in the treatment of hypertrophic scars and future studies will have to be directed at finding an optimal combination of treatments for each individual case. Our knowledge of scar biology progresses, and as more and more clinical trials are performed and new agents developed, further changes in the algorithms and better results can be expected.
Similar content being viewed by others
References
Singer AJ, Clark RA. Cutaneous wound healing. N Engl J Med 1999;341:738–46
Rockwell WB, Cohen IK, Ehrlich HP. Keloids and hypertrophic scars: a comprehensive review. Plast Reconstr Surg 1989;84: 827–37
Heden P. Non surgical management of hypertrophic scars: evidence-based therapies, standard practices, and emerging methods. Aesthetic Plast Surg 2007;31:468–92
Ward RS. Pressure therapy for the control of hypertrophic scar formation after burn injury: a history and review. J Burn Care Rehabil 1991;12:257–62
Neissen FB, Spauwen PH, Schalkwijk J, Kon M. On the nature of hypertrophic scars and keloids: a review. Plast Reconstr Surg 1999;104:1435–58
Alster TS, West TB. Treatment of scars: a review. Ann Plast Surg 1997;39:418–32
Tolhurst D. Hypertrophic scarring prevented by pressure: a case report. Br J Plast Surg 1977;30:218–9
Reish RG, Eriksson E. Scars: a review of emerging and currently available therapies. Plast Reconstr Surg 2008;122:1068–78
Chang P, Laubenthal KN, Lewis RW, Rosenquist MD, Lindley-Smith P, Kealy GP. Prospective, randomized study of the efficacy of pressure garment therapy in patients with burns. J Burn Care Rehabil 1995;16:473–5
Anzarut A, Olson J, Singh P, Rowe BH, Tredget EE. The effectiveness of pressure garment therapy for the prevention of abnormal scarring after burn injury: a meta-analysis. J Plast Reconstr Aesthet Surg 2009;62:77–84
Mann R, Yeong EK, Moore ML, Engrav LH. A new tool to measure pressure under burn garments. J Burn Care Rehabil 1997;18:160–3
Leung KS, Cheng JC, Ma GF, Clark JA, Choy TT, Leung PC. Complications of pressure therapy for post burn hypertrophic scars: biomechanical analysis based on 5 patients. Burns Incl Therm Inj 1984;10:434–8
Costa AM, Peyrol S, Porto LC, et al. Mechanical forces induce scar remodelling: study in non-pressure-treated versus pressure-treated hypertrophic scars. Am J Pathol 1999;155:1671–9
Reno F, Sabbatini M, Lombardi F, et al. In vitro mechanical compression induces apoptosis and regulates cytokines release in hypertrophic scars. Wound Repair Regen 2003;11:331–6
Shih R, Waltzman J, Evans GRD. Review of over-the-counter topical scar treatment products. Plast Reconstr Surg 2007;119: 1091–5
Fulton JE. Silicone gel sheeting for the prevention and management of evolving hypertrophic and keloid scars. Dermatol Surg 1995;21:947–51
Carney SA, Cason CG, Gowar JP, et al. Cica-Care gel sheeting in the management of hypertrophic scarring. Burns 1994;20:163–7
de Oliveira GV, Nunes TA, Magna LA, et al. Silicone versus nonsilicone gel dressings: a controlled trial. Dermatol Surg 2001;27:721–6
Gold MH, Foster TD, Adair MA, Burlison K, Lewis T. Prevention of hypertrophic scars and keloids by prophylactic use of topical silicone gel sheets following a surgical procedure in an office setting. Dermatol Surg 2001;27:641–4
O'Brien L, Pandit A. Silicon gel sheeting for preventing and treating hypertrophic and keloid scars. Cochrane Database Syst Rev 2006;Jan 25(1):CD003826
Steinstraesser L, Flak E, Witte B, et al. Pressure garment therapy alone and in combination with silicone for the prevention of hypertrophic scarring: randomized controlled trial with intraindividual comparison. Plast Reconstr Surg 2011; 128:306e–13e
Chernoff WG, Cramer H, Su-Huang S. The efficacy of topical silicone gel elastomer in the treatment of hypertrophic scars, keloid scars, and post-laser exfoliation erythema. Aesthetic Plast Surg 2007;31:495–500
Berman B, Flores F. Comparison of silicon gel-filled cushion and silicon gel sheeting for treatment of hypertrophic or keloid scars. Dermatol Surg 1999;25:484–6
Hanasono MM, Lum J, Carrol LA, et al. The effect of silicone gel on basic fibroblast growth factor levels in fibroblast cell culture. Arch Facial Plast Surg 2004;6:88–93
Roques C, Téot L. The use of corticosteroids to treat keloids: a review. Int J Low Extrem Wounds 2008;7:137–45
Manuskiatti W, Fitzpatrick RE. Treatment response of keloidal and hypertrophic sternotomy scars: comparison among intralesional corticosteroid, 5-fluorouracil, and 585-nm flashlamp-pumped pulsed-dye laser treatments. Arch Dermatol 2002; 138:1149–55
Ogawa R. The most current algorithms for the treatment and prevention of hypertrophic scars and keloids. Plast Reconstr Surg 2010;125:557–68
Mustoe TA, Cooter RD, Gold MH, et al. International clinical recommendations on scar management. Plast Reconstr Surg 2002;110:560–71
Lee KK, Mehrany K, Swanson NA. Surgical revision. Dermatol Clin 2005;23:141–50
Ogawa R, Mitsuhashi K, Hyakusoku H, Miyashita T. Postoperative electron-beam irradiation therapy for keloids and hypertrophic scars: retrospective study of 147 cases followed for more than 18 months. Plast Reconstr Surg 2003;111:547–53
Malaker K, Vijayraghavan K, Hodson I, Al Yafi T. Retrospective analysis of treatment of unresectable keloid with primary radiation over 25 years. Clin Oncol (R Coll Radiol) 2004;16: 290–8
Dinh Q, Veness M, Richards S. Role of adjuvant radiotherapy in recurrent earlob keloids. Australas J Dermatol 2004;45:162–6
Ragoowansi R, Cornes PG, Moss AL, Glees JP. Treatment of keloids by surgical excision and immediate postoperative single fraction radiotherapy. Plast Reconstr Surg 2003;111:1853–9
Ship AG, Weiss PR, Mincer FR, Wolkstein W. Sternal keloids: successful treatment employing surgery and adjunctive radiation. Ann Plast Surg 1993;31:481–7
Berman B, Bieley HC. Adjunct therapies to surgical management of keloids. Dermatol Surg 1996;22:126–30
Alster TS, Williams CM. Treatment of keloid sternotomy scars with 585 nm flashlamp-pumped pulsed-dye laser. Lancet 1995;345(8959):1198–200
Alster TS. Improvement of erythematous and hypertrophic scars by the 585 nm flashlamp-pumped pulsed dye laser. Ann Plast Surg 1994;32:186–90
Chan HH, Wong DSY, Ho WS. The use of pulsed dye laser for the prevention and treatment of hypertrophic scars in Chinese persons. Dermatol Surg 2004;30:987–94
Kono T, Ercocen AR, Nakazawa H, et al. The flashlamp-pumped pulsed dye laser (585 nm) treatment of hypertrophic scars in Asians. Ann Plast Surg 2003;51:366–71
Alster TS. Laser scar revision: comparison study of 585-nm pulsed dye laser with and without intralesional corticosteroids. Dermatol Surg 2003;29:25–9
McCraw JB, McCraw JA, McMellin A, et al. Prevention of unfavorable scars using early pulsed dye laser treatments: a preliminary report. Ann Plast Surg 1999;42:7–14
Allison KP, Kiernan MN, Waters RA, et al. Pulsed dye laser treatment of burn scars. Alleviation or irritation? Burns 2003; 29:207–13
Donelan MB, Parrett BM, Sheridan RL. Pulsed dye laser therapy and Z-plasty for facial burn scars. The alternative to excision. Ann Plast Surg 2008;60:480–6
Wittenberg GP, Fabian BG, Bogomilsky JL, et al. Prospective, single-blind, randomized, controlled study to assess the efficacy of the 585-nm flashlamp-pumped pulsed-dye laser and silicone gel sheeting in hypertrophic scar treatment. Arch Dermatol 1999;135:1049–55
Alster T. Laser scar revision: comparison study of 585-nm pulsed dye laser with and without intralesional corticosteroids. Dermatol Surg 2003;29:25–9
Kunzi-Rapp K, Wortmann S, Gottlöber P, et al. Treatment of hypertrophic scars and keloids on the bases of thermal induced collagen reactions by a new Erbium:YAG-laser. J Cut Laser Therapy 2001;3:32
Kunzi-Rapp KC, Dierickx C, Cambier B, Drosner M. Minimally invasive skin rejuvenation with Erbium: YAG laser used in thermal mode. Lasers Surg Med 2006;38:899–907
Rogge FJ, Cambier B. Safe and effective treatment of problem scars with the purely thermal non-ablative Er:YAG laser scar mode. J Cosmet Laser Ther 2008;10:143–7
Helbig D, Bodendorf MO, Grunewald S, Kendler M, Simon JC, Paasch U. Immunohistochemical investigation of wound healing in response to fractional photothermolysis. J Biomed Opt 2009;14:064044
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Wittgruber, G., Parvizi, D. & Koch, H. Nonsurgical therapy for postoperative hypertrophic scars. Eur Surg 44, 74–78 (2012). https://doi.org/10.1007/s10353-012-0076-9
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s10353-012-0076-9