Scar Prevention with Proper Wound Care

Dr. YAU Wah Hon

HKSH Resident Medical Officer

Specialist in Emergency Medicine

The skin is the largest organ of the human body. It separates the internal organs from the outside world as the first line of defense. It also gives us experience of pain or itchiness, pressure or touch, vibration or rest, warmth or coldness throughout our life.

Basic Skin Care: Moisturisation 

Basic skin care is all about water: you can enhance skin protection by simply keeping it moisturised every day. Without water, the skin loses elasticity. Even a piece of paper can cause cuts on fingers during the dry winter.

The use of skin moisturisers like Vaseline or natural moisturising factor/ceramide-containing products can keep the epidermis hydrated and enhance skin elasticity, thereby providing an effective layer against such injuries.  

Can I Manage the Wound by Myself? 

Skin injuries vary in level and mechanism. Most people can take care of mild scratches themselves, as the wounds can heal after a few days of wound rinsing with disinfectant and the use of ointment, antiseptic or antibiotic and adhesive bandage. Sometimes medical attention is needed to examine and manage the wound. It helps reduce the risk of complication as well as prevent functional impairment and scar formation.

1. Bruises and Blunt Injuries

Bruises and scratches are usually caused by collision, and the wounds must be cleaned thoroughly, cleared of any foreign objects and bandaged properly to avoid infection and scar formation. Superficial bruises can normally heal on their own in 2 to 3 weeks. As for skin tears caused by blunt trauma, the wound edges are mostly uneven and contaminated with foreign bodies. Tissue glue is considered for small, superficial and non-gapped wound, while for large or gapped wounds, sutures are used to minimise scar size and functional problems due to scar adhesion.   

2. Cuts

A cut is usually a clear break in the skin. In case of gapped or deep wounds, e.g. a stabbed wound, detailed examination is required to look for possibly injury to internal organs, tendons, blood vessels or nerves, and to decide if suture is required. 

3. Burns

Burns can cause boils formation and the pain is usually more intense. In case of extensive boils, doctor will first examine the burn area and depth, followed by proper wound care and painkiller prescription to reduce the risk of infection and scar formation. For injuries that are third-degree or above, patients may fail to recognise the severity and delay treatment because of the destroyed pain sensation. Scars often occur after third-degree burns, which require immediate medical attention and treatment. As regards chemical burns, the wound must be rinsed immediately, especially if it is caused by strong alkaline like caustic coda, which can cause deeper damage than strong acid.

Treatment Varies with Wound Location

Bacterial Infection Prone to Scar Formation

Treatment varies with injury mechanism, severity and also wound location. The scalp has many blood vessels. Even a minor wound requires sutures to stop bleeding. Face wounds must be managed with extra care to prevent scarring.

Wounds over the joints like the knees take longer time to heal. Every time we walk or sit down, the knees are flexed and the wounds are torn apart, which results in longer recovery period and scar formation.  

Sometimes an injury may cause further damage to the organs underneath the skin, e.g. concussion or bone fractures. Doctor will check how the injury occurred and arrange imaging examinations if necessary, such as X-ray, CT scan, etc. Referral to specialist is required in case of cerebral haemorrhage or bone fractures.

Scars can be caused by wound infection, and as a precaution the wound must first be rinsed before further treatment. Injuries caused by animal bites are especially prone to infection and usually need antibiotic prescription. Often found in animal oral cavities, anaerobic bacteria tend to flourish in a closed environment. Doctor will examine the wound carefully to determine if suturing is required immediately or can be performed later.

Take suture under local anaesthesia as an example, the wound must be thoroughly rinsed and carefully examined again when the anaesthesia is effective. All foreign bodies or necrotic tissues must be removed from the wound to reduce the risk of bacterial infection.

Sutures

Non-absorbable Sutures: Fewer Sutures Less Obvious Scars

Deeper wounds may require layered suture. For a traumatic wound, non-absorbable sutures are used for superficial wound closure. They cannot be degraded by the body with time, and are thus less likely to get loose when stretched. sutures can also be removed once the wound has healed up, but only in follow-up consultation.

As far as the number of suture is concerned, more stitches are required with finer sutures. The advantage is that the resulting wound becomes less obvious.

Wound Care

Different Dressing Materials Promotes Wound Healing and Reduces Scar Formation 

Wound dressing can provide favorable environment for wound healing. It controls bleeding, removes slough, provides moisture, absorbs odor, minimises bacterial growth, etc., thereby leading to smooth healing with fewer scars and complications. Different dressing materials are available for varying stages and situations.

Follow the instructions from the medical personnel as to which type of dressing material is to be used. Aseptic technique is usually applied in wound dressing, and the materials should keep intact to avoid contamination. 

Whether the wound is sutured or not, seek immediate medical attention if there is blood coming out of the dressing, worsening pain, redness, swelling, hotness in the wound, difficulty with movement, wound odor, fever or failure to heal during recovery.  

Scar Prevention after Suture Removal 

The skin should be fully healed at the time of suture removal and ready for scar care. You may need to apply preventive scar ointment or bandage to the wound for a few months or even over a year, i.e. until it fades to skin colour and bceomes flat. Seek medical attention if abnormal scar growth occurs during the period.

Scar-prone Skin

Some people are susceptible to scar formation, e.g. those with a history of keloid formation. Patients with diabetes, immunological problems or taking steroids are also at increased risk of wound infection and subsequent scar formation. 

The use of antiplatelet agents or anticoagulant medications for heart and neurovascular diseases may also increase the risk of wound bleeding or haematoma, leading to longer recovery and higher risk of infection and scarring.