Prevention and treatment of scars after bone plate fixation

The formation of scars after bone plate fixation is closely related to the depth and tension of the surgical incision, the risk of infection and the individual healing ability. Excessive hyperplasia of scars (such as hypertrophic scars or keloids) may affect joint movement, cause pain or trigger psychological burden. The following provides scientific and operational suggestions from three stages: prevention of scars, early intervention, and post-treatment.

First, the mechanism and risk factors of scar formation

The physiological process of scar formation

The postoperative incision healing undergoes the inflammatory stage (0-3 days), the proliferative stage (3 days -3 weeks), and the remodeling stage (3 weeks -2 years).

Excessive proliferation of proliferative fibroblasts and excessive deposition of collagen are the main causes of scar formation.

High-risk factors

Incision factors: High incision tension (such as near the joint), incision infection or hematoma formation.

Individual factors: teenagers, people with dark skin, keloid-prone constitution, family history.

Postoperative factors: Premature activity leading to incision dehiscence, insufficient local compression, and ultraviolet exposure.

Second, the core strategies for scar prevention

Reduce incision tension and optimize the healing environment

Incision design: During the operation, try to make the incision consistent with the skin tension line (Langer line) as much as possible to reduce postoperative tension.

Tension reduction measures:

After the operation, use tension-reducing adhesive tape or seat-free tape to stick perpendicularly to the incision to reduce the skin tension on both sides of the incision.

The joint area can be fixed with elastic bandages or braces to prevent the incision from splitting due to excessive movement.

Prevent infection and hematoma

Strict aseptic operation: Postoperative dressing changes should follow the aseptic principle to avoid incision contamination.

Timely treatment of hematoma: If the incision shows swelling, pain or a fluctuating sensation, it is necessary to seek medical attention promptly for drainage to prevent the organization of hematoma and the formation of scars.

Early anti-scar intervention

Application of silicone preparations:

Immediately after the incision heals (3 to 5 days after the stitches are removed), apply silicone gel or silicone dressings to inhibit scar hyperplasia through hydration.

Use it for 12 to 24 hours daily for 3 to 6 months (at the end of the scar remodeling period).

Stress therapy

For high-risk areas (such as the chest and shoulders), elastic pressure clothing or custom-made pressure pads can be used to continuously compress and inhibit scar hyperplasia.

The pressure should be maintained at 24-30 mmHg and worn for at least 23 hours every day.

Avoid stimulating factors

Sun protection: Avoid direct exposure to ultraviolet rays within three months after incision healing. When going out, use sunscreen (SPF≥30) or physical shielding (such as clothing and hats).

Avoid scratching: During the early stage of incision healing, there may be itching. Scratching or rubbing should be avoided to prevent irritation and scar hyperplasia.

Third, Early treatment of scars (proliferative stage)

Identification of hypertrophic scars

It is manifested as local redness, thickening and hardening of the incision, which may be accompanied by itching or pain, but not exceeding the original incision area.

Intervention measures

Drug treatment

Local injection of glucocorticoids (such as triamcinolone acetonide) can soften scars and relieve itching, but it should be performed by a doctor to avoid skin atrophy caused by frequent injection.

Topical onion extract preparations (such as certain gels) may inhibit fibroblast proliferation, but the effect varies from person to person.

Physical therapy

Laser treatment: Pulsed dye laser (PDL) can close the blood vessels within scars, reducing erythema and hyperplasia. Fractional laser can promote collagen remodeling.

Cryotherapy: For small areas of hypertrophic scars, liquid nitrogen cryotherapy can inhibit scar hyperplasia, but it is necessary to avoid pigment loss.

Fourth, post-treatment of scars (Maturity period)

Identification of mature scars

It usually enters the mature stage 6 to 12 months after the operation, manifested as the scar color becoming lighter (close to the skin color), the texture becoming softer and the thickness becoming thinner.

Methods for improving the appearance of scars

Surgical repair

For scars that seriously affect function (such as joint contracture), function can be improved through surgical release + skin grafting/flap repair.

For scars with high aesthetic demands (such as on the face), scar excision combined with fine suturing or Z-shaped reshaping can be adopted to reduce tension.

Laser and filling therapy

Exfoliating lasers (such as CO₂ lasers) can grind the surface of scars and improve the texture.

Non-ablative lasers (such as 1550nm erbium glass lasers) can stimulate collagen regeneration and reduce pigmentation.

Hyaluronic acid filling: For depressed scars, local flatness can be restored through filling.

Psychological support

Scars may cause psychological stress in patients (such as low self-esteem and anxiety), and it is necessary to help patients adjust their mindset through psychological counseling or support groups.

Fifth, precautions for scars in special areas

Scars on the joint area

Joint range of motion training should be carried out early to prevent scar contracture from causing joint stiffness.

It can be combined with wax therapy or ultrasound treatment to soften scars and improve their range of motion.

Facial scar

Avoid using irritating drugs or excessive physical therapy to prevent pigment loss or aggravation of scars.

Give priority to minimally invasive methods such as laser and microneedling to improve appearance.

Scars on the chest and shoulders

Such areas are high-risk zones for keloids and require strict adherence to tension reduction, stress therapy, and the use of silicone preparations.

If keloids occur (beyond the original incision range and continue to grow), a combined treatment of glucocorticoid injection, surgery and radiotherapy is required.

Sixth, Common misunderstandings in scar care

Misconception 1: The earlier you use scar cream/patches, the better

Analysis: The use of silicone preparations when the incision has not completely healed may cause infection or allergy.

Suggestion: Wait until the incision is completely closed (3 to 5 days after the stitches are removed) before starting to use it.

Misconception 2: Applying ginger or vitamin E can remove scars

Analysis: Without scientific basis, ginger may irritate the skin and cause allergies, and vitamin E may aggravate scar hyperplasia.

Suggestion: Avoid using unproven folk remedies and choose silicone preparations or stress therapy instead.

Misconception 3: Scars do not need treatment after they mature

Analysis: Although mature scars no longer proliferate, they may still affect appearance or function. It is still necessary to assess whether surgical or laser repair is required.

Suggestion: Return for a follow-up visit about one year after the operation for the doctor to assess the scar condition.

Seventh, self-management by patients and their families

Regular follow-up visits

Regular follow-up visits should be conducted at 1 month, 3 months, 6 months and 1 year after the operation. Doctors can dynamically assess the progression of scars and adjust the treatment plan accordingly.

Record the changes of scars

Patients can take photos of the scars with their mobile phones to record changes in color, thickness and texture, which is convenient for comparison during follow-up visits.

Healthy lifestyle

A balanced diet (supplementing with protein, vitamin C and zinc to promote healing), quitting smoking and limiting alcohol intake, and avoiding staying up late can help improve the quality of scars.