Intraoperative Interventions for Scar Optimization in Cutaneous Surgery: A Systematic Review

BACKGROUND Scarring is a common side effect of cutaneous surgery. Scarring has been linked to decreased quality of life and patient satisfaction after surgery. OBJECTIVE To provide a framework for dermatological surgeons to best choose intraoperative interventions to minimize scarring. METHODS A MEDLINE search was conducted using keywords: “surgical scars,” “scarring,” “scar intervention,” and “scar reduction.” Clinical trials and professional opinion pieces were included. Articles were excluded if they were not in the English language or did not describe interventions in the intraoperative period. RESULTS Variations in closure techniques and suture material can impact scar outcomes. Intraoperative abrasion of tissue through dermabrasion, electroabrasion, and laser ablation can also impact wound outcomes. Exogenous materials, such as botulinum toxin, intralesional steroids, platelet preparations, and human mesenchymal stem cells, can be utilized to promote improved wound healing. No single best intervention for scar optimization was determined, but varying interventions may be used based on specific patient and wound characteristics. CONCLUSION Many intraoperative options exist for dermatological surgeons to improve scarring outcomes. Wound and patient characteristics can be utilized in selecting the most effective interventions for a given patient.