Pathophysiology of post-operative scars

Abstract

BACKGROUND: Major surgical procedures result in varying degrees of scar as a visible endpoint of wound healing. Efforts to minimize post-operative scar formation that can lead to painful or unsightly scars have been motivated by the unpredictability and potential for abnormal scarring. The formation of scars following surgery is of particular interest to plastic surgeons. We review here the classic stages of wound repair and the mechanical forces that affect post-operative scarring. METHODS: The peer-reviewed literature within the last 10 years was studied using an evidence-based approach. RESULTS: Pre-clinical and clinical studies suggest that post-operative scar formation begins with the surgical incision and is influenced by the local wound environment as it passes through the classic stages of inflammation, proliferation and remodeling. Mechanical forces including tension, depth and epidermal closure all influence scarring as demonstrated in animal models and clinical experience. Dermal regeneration templates have both scar reductive and regenerative properties. Current scar therapy includes compression therapy, silicone gel sheeting, radiation therapy and molecular therapy albeit with variable success. CONCLUSIONS: Post-operative scar forms as the result of a highly conserved cascade of events following surgery that seeks to restore skin integrity and is influenced by the wound environment's physical properties likely through cellular mechanotransduction. While current therapies seek to minimize scar formation based on our understanding of these forces, further research on the molecular and mechanical forces affecting post-operative scarring will allow for clinical applications to minimization scar formation.