How to Prevent Scarring on Ankle Wounds After Injury

How can I prevent scars from forming on wounds around the ankle joint?

I previously had a fibula fracture from a car accident, and I had a 7 cm incision at the ankle joint that was closed with staples.
I was in a cast for several weeks, and now, after more than four months, the area is slightly red but quite smooth without any protrusions.
Could it be that the cast kept the joint immobile for a period of time, which is why the wound appears so smooth? A few days ago, I went to the hospital to have the metal screws removed.
The incision was small, about 1.5 cm, and the doctor said that staples couldn't be used for closure, so they opted for sutures instead.
Does using sutures make it more likely to leave a scar? I'm concerned about scarring, especially since the wound is located at the ankle joint.
I'm worried that moving the joint while walking might affect scar formation.
What can I do to prevent scarring on the ankle wound? Thank you.

Xiao Ling, 20~29 year old female. Ask Date: 2005/04/06

Dr. Huang Ruiyun reply Dermatology

There are many factors that affect scarring in joint areas.
It is recommended that you purchase silicone sheets designed for scars from a medical supply store and apply them patiently for two years, or at least for six months.
This will help make the scars smoother, but it is unlikely that they will be completely scar-free.

Reply Date: 2005/04/06

More Info

To prevent scarring on ankle wounds after an injury, it is essential to understand the healing process and the factors that can influence scar formation. Scarring is a natural part of the healing process, but there are several strategies you can employ to minimize the appearance of scars, especially in areas like the ankle that are subject to movement.

Understanding Scar Formation
When the skin is injured, the body initiates a healing response that involves several phases: hemostasis, inflammation, proliferation, and remodeling. During the proliferation phase, new tissue forms, and this is when scars begin to develop. The type of closure used (staples, sutures, or adhesive) can influence the final appearance of the scar. Generally, sutures may provide a more precise closure, which can lead to better cosmetic outcomes compared to staples, especially in delicate areas like the ankle.

Factors Influencing Scarring
1. Wound Care: Proper wound care is crucial. Keeping the wound clean and moist can promote healing and reduce scarring. Use a gentle cleanser and apply a thin layer of antibiotic ointment to prevent infection, which can worsen scarring.

2. Movement and Tension: Since the ankle is a joint that experiences constant movement, it is important to minimize tension on the wound. Activities that stretch the skin around the wound can lead to wider scars. Try to avoid excessive movement or strain on the ankle during the early healing phase.

3. Sun Protection: Protecting the healing skin from sun exposure is vital. UV rays can darken scars and make them more noticeable. Use a broad-spectrum sunscreen with an SPF of at least 30 on the scar once it has healed sufficiently, or cover it with clothing.

4. Moisturization: Keeping the scar moisturized can help improve its appearance. After the wound has closed, consider using silicone gel sheets or silicone-based scar creams, which have been shown to be effective in reducing scar formation.

5. Massage: Once the wound has healed, gentle massage of the scar tissue can help break down collagen fibers and improve the scar's appearance. Use a moisturizing lotion or oil to facilitate the massage, and be gentle to avoid causing pain or irritation.

6. Hydration and Nutrition: Staying well-hydrated and maintaining a balanced diet rich in vitamins and minerals can support the healing process. Vitamins A, C, and E, as well as zinc, play important roles in skin repair and regeneration.

7. Consultation with Specialists: If you are particularly concerned about scarring, consider consulting a dermatologist or a plastic surgeon. They can provide treatments such as laser therapy, microdermabrasion, or steroid injections that can help improve the appearance of scars.

Conclusion
In summary, while some degree of scarring is inevitable after an injury, there are numerous strategies you can employ to minimize its appearance, especially on the ankle. Proper wound care, minimizing movement, protecting the area from sun exposure, and using silicone products can all contribute to better outcomes. If you have ongoing concerns about the appearance of your scar, do not hesitate to seek professional advice. Remember that patience is key, as scars often continue to mature and fade over time.

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