Optimal Timing for Scar Revision Surgery in Children

Timing for Scar Revision Surgery

Hello Dr.
Luo,
My daughter is four years old this year.
Due to some complications at birth, she requires high-dose nutritional intravenous therapy.
During the administration of this therapy, there were some issues, and the nurse explained that high-dose nutritional IV therapy can easily cause vascular rupture in young children, resulting in approximately 70% necrosis on the dorsal surface of her left hand.
If the nerves were affected, she might not be able to use her left hand normally.
Fortunately, by the grace of God, she has shown no abnormality in her movements so far, but the scar has become increasingly noticeable, corresponding to the 70% area affected.
To prevent any psychological barriers when she starts kindergarten, I would like to ask Dr.
Luo: what is the best timing for scar revision surgery? Thank you very much for your assistance!

Xiao Lü, 30~39 year old female. Ask Date: 2003/01/01

Dr. Luo Qihua reply Plastic Surgery

Once a scar forms, current medical standards do not allow for its complete disappearance.
When a scar is newly formed, silicone sheets and compression garments should be applied to the scar for at least one year to minimize its hypertrophic state.
The formation of scars can impact both function and aesthetics.
If a scar causes contracture that affects the range of motion in a joint, such as the inability to fully grip or extend a finger, and there is no improvement after 3-6 months of rehabilitation therapy, surgical options such as scar release and skin grafting may be considered to improve joint mobility.
For aesthetic reasons, if there are still significant hypertrophic scars after at least one year of rehabilitation and pressure therapy (compression garments), scar revision surgery may be an option.
However, if the scar on the back of the hand covers a large area (70%), whether to perform excision followed by skin grafting or to use tissue expanders (balloons) to stretch the skin before repairing the scar must be evaluated directly by a plastic surgeon in consultation with the patient.
Since the injury occurred over three years ago and the patient is approaching school age, it would be advisable to consult with a plastic surgeon.

Reply Date: 2003/01/01

More Info

When considering the optimal timing for scar revision surgery in children, several factors must be taken into account, including the child's age, the maturity of the scar, and the overall health of the child. In your case, your daughter is currently four years old, and her scar covers approximately 70% of the dorsal surface of her left hand. Given the nature of her injury and the potential psychological impact of visible scarring, it is understandable that you are seeking guidance on when to proceed with scar revision.

1. Timing for Scar Revision Surgery:
Scar revision surgery is typically considered once the scar has matured. Scars usually go through several stages of healing, and the maturation process can take anywhere from six months to two years. During this time, the scar may change in color, texture, and size. For children, it is often recommended to wait until the scar has matured to ensure the best possible outcome from the surgery. This maturation period allows the scar to settle and become less vascularized, which can lead to a more favorable surgical result.

In your daughter's case, since she is four years old and the scar is still relatively new, it may be advisable to wait until she is at least five or six years old before considering surgical intervention. This timeframe allows for the scar to mature and for any potential growth changes in her hand to be taken into account.

2. Psychological Considerations:
The psychological impact of scarring on children should not be underestimated. Visible scars can affect a child's self-esteem and social interactions, especially as they begin school. If the scar is causing significant distress or affecting her willingness to engage with peers, it may be worth discussing with a pediatric psychologist or counselor. They can provide strategies to help her cope with any feelings of self-consciousness while you wait for the appropriate time for surgery.

3. Surgical Options:
When the time is right for scar revision, several surgical techniques can be employed, including excision of the scar tissue, dermabrasion, or laser therapy. The choice of technique will depend on the characteristics of the scar, such as its thickness, texture, and location. A consultation with a pediatric plastic surgeon who specializes in scar revision will provide you with tailored options based on your daughter's specific situation.

4. Post-Surgery Care:
After scar revision surgery, proper care is crucial for optimal healing. This includes keeping the area clean, applying prescribed ointments, and possibly using silicone sheets or gels to help flatten and soften the scar. Regular follow-up appointments will also be necessary to monitor the healing process and address any concerns that may arise.

In conclusion, while it is understandable to want to address your daughter's scar as soon as possible, waiting until the scar has matured is generally the best approach. This timing will not only improve the surgical outcome but also allow for a more comprehensive assessment of her growth and development. In the meantime, consider seeking support for her emotional well-being as she navigates her feelings about her scar. Consulting with a pediatric plastic surgeon will provide you with the best guidance on the timing and options for scar revision surgery.

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