Scar Management

Silicone gel and silicone sheet used for scar management
Figure 1. Silicone gel.

Scar formation is a normal response following any injury or surgery. It is the way the body heals injured structures. Scar tissue may involve only the superficial skin, or it may involve deeper tissues beneath the skin, including nerves and tendons.

An active scar may be red, raised, firm, and thick. Scars can become overly sensitive and can limit motion and function.

Treatment

Your hand surgeon or hand therapist may recommend a variety of treatments once your injury is healed, cuts are closed, and stitches are removed. Timing of scar treatments varies depending on the type of injury or surgery.

Scar management treatments may include:

  • Scar massage can help decrease sensitivity and loosen deeper areas that seem stuck. Scar massage helps produce a smooth, moveable scar. You can use an over-the-counter cream such as Vaseline, cocoa butter, or hand lotion. The tissue should be massaged in the direction of the scar for ten minutes twice a day. This may be useful for 3-6 months or for as long as it seems to help.
  • Early controlled exercise programs can prevent stiffness of nearby joints and keep tendons gliding under the skin.
  • Silicone gel can be placed on the scar in sheets or in liquid form. Silicone sheets can be washed and reused. Silicone gel dries as a very thin layer and stays on curved skin surfaces that move throughout the day. Silicone therapy is often used 12-24 hours a day for 3-6 months. Taping or wrapping the scar can help reduce swelling and tension.
  • Massage, vibration, and rubbing the scar with different textures can help overly sensitive scars. This may help the skin and nerves become more tolerant of everyday touch and pressure. This process of desensitizing the scar can take up to 4 months and can start once the skin and repaired tissues have healed.
  • Injections or surgery can be effective for special scar problems. Burn scars or more serious injuries may require aggressive treatment. Special gloves or topical treatment may be used for burn scars.
Illustration showing phases of scar healing over time
Figure 2. Scar phases.

Some scars take up to a year to mature. For this reason, some scar revisions, which are surgeries that minimize a scar so it blends in, may not be offered until a year after injury or surgery. Scars have completed the healing process when they are light in color, smooth, and no longer sensitive to touch. A fresh, healing scar that is pink, red, raised, thick, or sensitive should be protected from sunlight because sun exposure can darken it.

Healing

After the skin and deeper tissues have healed, the scar goes through four stages of healing. Although the initial skin scar may be minimal, the scar often enlarges and becomes more red over the following 4-6 weeks. An active scar is typically red, raised, firm, and thick. Sometimes this change can be confused with infection. The outermost layer may also loosen while deeper layers remain intact; this is normal.

Following the swelling and reddening phase, the wound becomes smaller and paler over the next 2-3 months. Later, the scar usually becomes soft and has a more natural color.

This mobile-friendly version is adapted from patient education content originally provided by the American Society for Surgery of the Hand.