Managing Scar Tissue After Fracture Surgery: Concerns and Solutions - Orthopedics

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Managing scar tissue after fracture surgery, especially in the context of hypertrophic scars or keloids, can be a complex issue that requires careful consideration and management. Your concerns about the potential for your existing scar to worsen after the removal of the internal fixation plate are valid and deserve a thorough response.

Firstly, it is important to understand that scars, particularly hypertrophic scars and keloids, can behave unpredictably. Hypertrophic scars are raised scars that remain within the boundaries of the original wound, while keloids extend beyond the original injury site. Given your history of keloid formation, it is crucial to approach any surgical intervention with caution.

1. Surgical Considerations: When the surgeon removes the plate, they will likely need to make an incision along the existing scar. This can potentially lead to an increase in scar tissue formation, especially if the skin is under tension during the healing process. The risk of the scar becoming larger, more raised, or more prominent is indeed a concern, particularly in individuals with a predisposition to keloid formation. It is essential to discuss this with your surgeon, who may have strategies to minimize scar formation, such as using specific suturing techniques or tension-relieving methods.

2. Scar Management Post-Surgery: After the removal of the plate, it is advisable to continue with scar management techniques. While you mentioned using silicone gel, which is a common and effective treatment for hypertrophic scars, it may take time to see significant results. Consistent application is key, and it may be beneficial to combine this with other treatments. Options include:
- Pressure Therapy: Applying pressure garments can help flatten and soften scars over time.

- Steroid Injections: These can be effective in reducing the size and appearance of hypertrophic scars and keloids. However, as you noted, there is a possibility of recurrence, especially if the scar is located over a joint where movement can stimulate scar tissue formation.

- Laser Therapy: Certain types of laser treatments can help reduce the appearance of scars and improve skin texture.

- Microneedling: This technique can promote collagen remodeling and may help improve the appearance of scars.

3. Monitoring and Follow-Up: After the surgery, it is crucial to have regular follow-ups with your healthcare provider. They can monitor the healing process and the appearance of the scar. If you notice any changes or if the scar begins to thicken or become more prominent, it is important to address these concerns promptly.

4. Emotional and Psychological Support: Living with scars, especially those that are raised or disfiguring, can have emotional and psychological impacts. It may be beneficial to seek support from counseling or support groups for individuals dealing with similar issues.

In summary, while there is a risk that the scar may become larger or more pronounced after the removal of the internal fixation plate, careful surgical technique and proactive scar management can help mitigate this risk. Open communication with your surgeon about your concerns and preferences will be essential in developing a plan that addresses both the functional and aesthetic aspects of your recovery.