title: Updated scar management practical guidelines: non-invasive and invasive measures.
abstract: Hypertrophic scars and keloids can be aesthetically displeasing and lead to severe psychosocial impairment. Many invasive and non-invasive options are available for the plastic (and any other) surgeon both to prevent and to treat abnormal scar formation. Recently, an updated set of practical evidence-based guidelines for the management of hypertrophic scars and keloids was developed by an international group of 24 experts from a wide range of specialities. An initial set of strategies to minimize the risk of scar formation is applicable to all types of scars and is indicated before, during and immediately after surgery. In addition to optimal surgical management, this includes measures to reduce skin tension, and to provide taping, hydration and ultraviolet (UV) protection of the early scar tissue. Silicone sheeting or gel is universally considered as the first-line prophylactic and treatment option for hypertrophic scars and keloids. The efficacy and safety of this gold-standard, non-invasive therapy has been demonstrated in many clinical studies. Other (more specialized) scar treatment options are available for high-risk patients and/or scars. Pressure garments may be indicated for more widespread scarring, especially after burns. At a later stage, more invasive or surgical procedures may be necessary for the correction of permanent unaesthetic scars and can be combined with adjuvant measures to achieve optimal outcomes. The choice of scar management measures for a particular patient should be based on the newly updated evidence-based recommendations taking individual patient and wound characteristics into consideration.
authors.affiliation: Plastic and Reconstructive Surgery Department, Burn Centre, Ghent University Hospital, Ghent, Belgium. Electronic address: Stan.Monstrey@UGent.be.
authors.forename: Stan
authors.initials: S
authors.lastname: Monstrey
authors.affiliation: Association of Dutch Burn Centres, Beverwijk and Department of Plastic Reconstructive and Hand Surgery, Research Institute MOVE, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Esther
authors.initials: E
authors.lastname: Middelkoop
authors.affiliation: Department of Plastic and Reconstructive Surgery, KUL Leuven University Hospitals, Leuven, Belgium.
authors.forename: Jan Jeroen
authors.initials: JJ
authors.lastname: Vranckx
authors.affiliation: Plastic Surgery Institute, University of Padova, Padua, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Bassetto
authors.affiliation: Plastic and Aesthetic Surgery, Stuttgart Sporerstrasse, Germany.
authors.forename: Ulrich E
authors.initials: UE
authors.lastname: Ziegler
authors.affiliation: Geriatric Department, Rothschild Hospital, University of Paris 6, Paris, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Meaume
authors.affiliation: Wound Healing Unit and Burns Surgery, Montpellier University Hospital, Montpellier, France.
authors.forename: Luc
authors.initials: L
authors.lastname: Téot
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D017439:Cicatrix, Hypertrophic / Q000628:therapy*; D058128:Compression Bandages; D017679:Cryotherapy; D006801:Humans; D015552:Injections, Intralesional; D007627:Keloid / Q000628:therapy*; D053685:Laser Therapy; D011183:Postoperative Complications / Q000628:therapy*; D017410:Practice Guidelines as Topic; D012828:Silicones / Q000627:therapeutic use; D016038:Skin Transplantation; D015626:Tissue Expansion
chemical_list: D000305:Adrenal Cortex Hormones; D012828:Silicones
keywords: Guideline; Plastic surgeon; Scar; Silicone; Surgery