A Narrative Review of Scars After Surgery: What to Expect

Background and Objective: For most surgical procedures, postoperative scars are inevitable. Scars that heal with poor cosmetic appearance or physical symptoms such as pain, pruritis, or tethering can have a negative impact on a patient’s quality of life. This review aims to identify current techniques for prevention of unfavorable scar formation and treatment of unfavorable scars. Methods: A narrative review of the literature was conducted using our institution’s Primo search engine to search online databases including PubMed and EBSCO, among others. Included references were selected by the first author based on relevance to the subject matter and availability in English. Key Content and Findings: Wound healing occurs as a series of complex phases: hemostasis, inflammation, proliferation, and remodeling. Deviation from the normal progression through these phases can contribute to unfavorable scar formation. Intraoperatively, meticulous tissue handling as well as suture selection can help decrease the likelihood of unfavorable scar formation. Topical silicone and pressure dressings can be used to prevent unfavorable scars as well as to treat unfavorable scars in their early stages. Laser resurfacing, dermabrasion, and intralesional corticosteroid injections can improve unfavorable scars weeks to months after they occur. Finally, surgical excision and revision is an option for unfavorable scars that do not improve with more conservative therapies. Conclusions: There are preventative measures to consider in the intraoperative and early postoperative period to help prevent the formation of unfavorable scars. Despite these efforts, unfavorable scars can still form in some patients. Understanding normal wound healing and scar formation, factors that contribute to unfavorable scar formation, and the options to revise and improve unfavorable scars can help improve patient outcomes