Many patients daily seek out their local emergency departments across the country to treat open wounds, which usually involve primary closure with sutures or staples. Open wounds make up approximately 4.5% of ER visits annually. Most of this volume is seen in the warmer months of spring and summer when people spend more time outdoors.
Wound management for my patients involves many complex choices. In the ED, I have to decide what type of wound closure material to choose—steri-strips, glue, staples, or sutures—based on wound site, size, and level of contamination. When I choose sutures, there are additional options, including size, thickness, and absorbability. Patients are then instructed to return to the ED at a later date — again, depending on the location of the wound — to have the suture material removed.
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These are all very important steps in wound management in the ED. But perhaps an equally important, often overlooked step is the prevention and treatment of scarring.
How do scars form?
The skin is the largest organ in the body and an important part of the immune system as a protective barrier against germs such as bacteria. When damaged, our body generates collagen protein to close the wound and protect us from infection.
Although aesthetically pleasing, a scar is the body’s natural way of healing and replacing lost or damaged skin. Spots do not always occur and depend on several factors:
Size, severity, and location of the initial wound Whether you received prompt care, including stitches for the injury, or had it close on its Presence of infection Age, genes, ethnicity, and general health or presence of other medical problems such as diabetes and high blood pressure
The main difference between a scar and the tissue it replaces is its alignment. While both contain collagen, scar tissue collagen is less organized in a single direction, while the original tissue had a more complex, basket-tissue type formation. Scar tissue collagen is also thicker and discolored.
How to prevent scars?
First of all, clean the wound when the injury occurs. Tap water alone is sufficient to clean the wound. Avoid more toxic, tissue-damaging antiseptics such as hydrogen peroxide or alcohol.
Everyone puts hydrogen peroxide on their wounds: they really shouldn’t.
Second, get medical help. Sutures, or sutures, to close larger wounds can minimize the risk of scarring. The same goes for treatment with oral antibiotics if your doctor thinks the wound is contaminated and prone to infection. I like to avoid topical antibiotics such as Neosporin on my patients as many of them develop allergic contact dermatitis from their use.
Scar Treatment: What’s the Latest?
So you immediately sought medical attention, got some stitches, and your wound is healing well with no infection. But it looks like a scar is forming. Or you suffered a wound months ago, and there is still a scar. What can you do?
First of all, remember that scars can continue to fade for up to two years. After that time, unfortunately, it is unlikely that there will be another natural change in the appearance of scars.
Avoid products that contain topical vitamin E. Long considered a popular addition to topical creams to treat scars, multiple studies have consistently shown that topical vitamin E is ineffective and can cause contact dermatitis — irritation and itching at the scar site — in about a third of people who use it and use it. Appearance of the scar may deteriorate.
Please kScar tissue is more sensitive to changes in appearance from UV light than normal skin tissue, so sunscreen is a must if you are concerned about the appearance of the scar. Both Vaseline and Aquaphor protect the skin and keep the scar tissue hydrated. Keep it simple and apply petroleum jelly with sunscreen.
It is impossible to remove scars without more advanced surgical techniques completely. But there are many so-called scar creams on the market that can help minimize the appearance of a spot. There is a lack of high-quality studies to evaluate these creams independently, but anecdotally, products containing some of the following active ingredients have seen many positive responses:
AllantoinAllicinPanthenol
Silicon dioxide sheets soften and flatten scars and have consistent support in the research literature. These sheets mimic the natural skin barrier to trap moisture against the skin’s surface. This hydration, in turn, reduces the itchiness associated with scarring.
More intense treatment options include dermabrasion, corticosteroid injections, laser treatment, cryotherapy, dermal fillers, or scar revision surgery. Consider a consultation with a dermatologist to explore these more advanced alternatives.
It comes down to the? Scarring is a natural process to replace damaged tissue. Scars can fade after years. Stick to a combination of regular petroleum jelly and sunscreen or silicone sheets to keep scar tissue hydrated and protected from UV rays that can further alter its appearance. Avoid products with topical vitamin E – there is no evidence that it works and can cause contact dermatitis on the spot. Consult your dermatologist for more advanced treatment options.
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Michael Daignault, MD, is a board-certified ER physician in Los Angeles. He studied Global Health at Georgetown University and received a medical degree from Ben-Gurion University. He completed his residency training in emergency medicine at Lincoln Medical Center in the South Bronx. He is also a former United States Peace Corps volunteer. Find him on Instagram @dr.daignault.
