Managing Thick Scars After Wrist Surgery: Effective Treatments and Tips

Scar after wrist joint surgery?

In January and February of last year, I was involved in a car accident and had my arm in a cast for over two months.
After the cast was removed, I noticed bone spurs forming in my wrist joint a few weeks later.
In April and May, I underwent another surgery, and shortly after, I noticed that the wound was swollen.
My family bought a lot of silicone gel sheets for me to apply.
Now, the wound doesn't seem to have changed much; it looks dark and raised, but it hasn't extended like a keloid, only within the wound area.
Is this hypertrophic scarring? What should I do now? (It's been about six months, and I hope to reduce the scar's appearance.) Should I continue using the silicone gel sheets, or what should I do?

Mr. Huang, 10~19 year old female. Ask Date: 2016/01/19

Dr. Wu Yuxin reply Dermatology

It could be hypertrophic scars.
Some may gradually flatten over the years, but if you're looking for quicker results, you can consider scar injection treatments at a dermatology clinic.

Reply Date: 2016/01/19

More Info

Managing thick scars after wrist surgery can be a challenging process, especially when the scars are still prominent months after the procedure. Based on your description, it sounds like you may be dealing with hypertrophic scars, which are raised and thickened areas of scar tissue that can develop after an injury or surgery. These scars can be red, itchy, and sometimes painful, but they typically remain within the boundaries of the original wound, unlike keloids, which extend beyond the wound site.

Understanding Hypertrophic Scars
Hypertrophic scars occur due to an overproduction of collagen during the healing process. They are often the result of factors such as the depth of the injury, the tension on the skin, and individual healing responses. While they can fade over time, they may take several months to years to mature, and in some cases, they may not improve significantly without intervention.

Treatment Options
1. Silicone Gel Sheets or Silicone Gel: Continuing to use silicone gel sheets or silicone gel is a well-supported method for managing hypertrophic scars. These products help to hydrate the scar tissue and create an optimal healing environment. They can also help flatten and soften the scar over time. It is recommended to use these products consistently for several hours a day, ideally 12-24 hours.

2. Pressure Therapy: Applying pressure to the scar can also be beneficial. This can be done using specialized garments or bandages designed to apply consistent pressure to the scar area. This method is particularly effective for scars that are raised.

3. Topical Treatments: In addition to silicone, you may consider topical treatments that contain ingredients like onion extract (found in products like Mederma), vitamin E, or other scar-reducing compounds. However, the efficacy of these treatments can vary, and they may not be as effective as silicone-based products.

4. Steroid Injections: If the scar remains thick and bothersome, corticosteroid injections can be administered by a healthcare professional. These injections can help reduce inflammation and flatten the scar. This treatment is typically done in a series of sessions.

5. Laser Therapy: For more persistent scars, laser therapy may be an option. This treatment can help reduce redness and improve the texture of the scar. It is usually performed by a dermatologist or plastic surgeon.

6. Surgical Revision: In some cases, if the scar is particularly bothersome or does not respond to other treatments, surgical revision may be considered. This involves removing the scar tissue and re-closing the wound in a way that minimizes the chance of a new scar forming.

Additional Tips for Scar Management
- Sun Protection: Protecting the scar from sun exposure is crucial. UV rays can darken scars and make them more noticeable. Use a broad-spectrum sunscreen with an SPF of 30 or higher on the scar when exposed to sunlight.

- Moisturization: Keeping the scar moisturized can help improve its appearance. Use fragrance-free moisturizers to avoid irritation.

- Avoid Irritation: Be cautious with activities that may irritate the scar, such as vigorous exercise or tight clothing.
- Consult a Specialist: If you notice no improvement or if the scar becomes painful, itchy, or shows signs of infection, it is essential to consult with a dermatologist or a plastic surgeon. They can provide a tailored treatment plan based on your specific situation.

Conclusion
In summary, managing hypertrophic scars after wrist surgery involves a combination of consistent use of silicone products, potential pressure therapy, and possibly medical interventions like steroid injections or laser therapy. It’s important to be patient, as scar maturation can take time, and results may vary based on individual healing processes. Regular follow-ups with a healthcare professional can help monitor the scar's progress and adjust treatment as necessary.

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