Scars

What is a scar

Scar tissue develops as a result of a tissue injury, an open wound or during normal wound healing after suturing. A scar can heal inconspicuously in the form of a line, broad, indented or bulging. Bulging, rough scars are also known as "hypertrophic scars". In the case of very severe scar proliferation, combined with itching and pain, the term "keloid" is used.

Different types of scar

Healed scar in the shape of a line:

Normal wound healing, inconspicuous scar

Trough-shaped scar (hypotrophic scar), acne scars:

Trough-shaped scars are a depression in the skin with loss of the cushioning layer of fat. The causes are varied and can occur, for example, as a result of acne or cortisone injections with atrophy of the fatty tissue.

Painfully retracted scar:

In the case of painful scars, the cause is often a retraction of the skin onto the underlying muscles. The cushioning layer of fat between the skin and muscles is missing. This results in a painful retraction that can cause problems, especially during movement.

Rough, thickened scar (hypertrophic scars):

Raised, broad and coarsely healed scar, which can also be painful.

Proliferating scar (keloid):

This is a very severe scar proliferation beyond the edge of the wound, associated with itching and pain. Keloids tend to occur above the breastbone, on the shoulders and ears.

Information on scar treatment

Depending on the cause and type of scar, there are a variety of treatment options:

Healed scar in the shape of a line:

A normal skin care cream is sufficient here, possibly apply Bepanthen ointment twice a day (dexpanthenol, vitamin A).

Trough-shaped scar (hypotrophic scar), e.g. acne scars:

There are various treatment options:

1. Surgical needling (link to the needling text)
2. Autologous fat transplantation (link to autologous fat text)
3. Surgical removal and tension-free wound suturing

Painfully retracted scar:

Surgical correction:

• In this case, surgical correction with removal of the painful scar cord and relining of the scar with well-perfused fatty tissue is advisable.
• Alternatively, a scar cord can be loosened in a minimally invasive procedure using a special instrument through a small incision in the skin and relined with autologous fat.

Rough, thickened scar (hypertrophic scars):

• Dermojet treatment: It makes sense to inject cortisone (triamcinolone, Volon A) at an early stage in order to slow down further growth and flatten the scar. This injection is carried out using a special high-pressure injection device (Dermojet), is performed on an outpatient basis over several weeks (every 2-3 weeks) and takes just a few minutes. The treatment is well tolerated thanks to the combination with a local anesthetic in the Dermojet device.
• Dermabrasion uses a special, high-frequency grinding device to remove the uppermost layers of skin. This flattens the scar, but does not make it completely invisible.

Surgical correction is advisable in the event of problems and pain:

• Excision of the scar and tension-free closure of the wound
• In the case of strand-shaped scars, e.g. on areas bridging joints such as fingers, armpits, groin, knees, neck, surgical correction by moving skin areas (e.g. Z-plasty) or applying a skin graft (full skin or split skin) is advisable.

Burn scars:

Depending on the location and type of scar (flat or cord-like), the following are possible options:

Two-dimensional scar:

• Silicone treatment and compression using e.g. compression garments, pressure pads
• Abrasion (dermabrasion) and e.g. Re-Cell therapy
• Surgical needling of the scar in several surgical sessions, possibly in combination with Co2 laser
• Insertion of an expander to stretch the adjacent healthy skin over 3-6 months. Removal of the expander, excision of the extensive burn scar and use of the stretched, healthy skin to close the wound.
• Removal of an extensive scar and application of a skin graft (full skin or split skin)

Strand-shaped scar:

• Excision of a scar strand and dissolution of the scar by moving skin areas (e.g. Z-plasty) or application of a skin graft (full skin or split skin)

Proliferating scar (keloid):

For keloids, if possible not surgery, as this can cause the scar to grow even more aggressively.

• It makes sense to inject cortisone (triamcinolone, Volon A) at an early stage in order to slow down further growth and flatten the scar. This injection is carried out using a special high-pressure injection device (Dermojet), is performed on an outpatient basis over several weeks (every 2-3 weeks) and takes a few minutes.
• The effect of this treatment can be further improved with silicone pressure pads and compression.
• If there is no response to dermojet treatment, surgical removal followed by radiotherapy (X-ray irradiation to slow down growth) may be considered after the patient has been informed in detail about the risk of recurrence and worsening of the condition.
• Alternatively, local icing of the tissue (cryotherapy) can be used.

General recommendation for scar treatment

For scar care, we recommend scar ointments such as Kelocote®, Scarban®, Contractubex® or Bepanthen® Scar Gel. Alternatively, a self-adhesive silicone plaster can be used. These are available from pharmacies. After removing the skin stitches, you should treat the scars twice a day with a scar gel until the scars become softer overall. The gel should be applied for at least 3 months to achieve a good result. Depending on the age of the patient, a scar can be shaped for approx. 1-2 years. The scar treatment should therefore be carried out consistently

Hospital stay and anesthesia

Scar treatment can be performed under local anesthesia of the surrounding tissue or under general anesthesia. A hospital stay is not usually necessary for scar treatment (except for expander insertion).