Can My Ankle Scar Be Improved By Some Form Of Scar Revision?
Q: Hi Dr Eppley, I have been reading with interest on the extensive archive of questions that you have previously responded to pertaining to scar revision. In one of the replies posted, you wrote that the extremities presents the most difficult anatomical sites on which to perform surgical revision. I have a long fairly wide <1 cm in most places) surgical scar sustained from ankle fracture surgery. It is slightly raised in areas, and slightly depressed in certain areas. It has been 3 yrs so it is actually no longer red but pale, shiny and wrinkled in areas. The scar bothers me greatly so I’ll really wish for it to be aggressively treated. I understand that the skin is thicker and more prone to shear /mechanical forces as explained in your response. If I plan to stay at home over the course of the entire recovery period and restrict movement to an absolute minimum, will this help my recovery to a large degree? I will also want to do taping/apply pressure (perhaps in the form of a compression garment or silicone sheeting) to prevent any widening of the scar. As an adjunct, I could possibly have dermabrasion or laser early in my recovery to improve the aesthetic outcome. Do you believe this to be a reasonable approach/treatment plan for improvement of my scar? Apologies in advance for the numerous questions; I’ll be extremely grateful if you can spend a few minutes of your time addressing the points I have raised above. Many many thanks!
A: Scars over the ankle are particularly difficult to improve. Since it is a wide scar, the primary basis for its treatment would be surgical excision (scar revision by cutting it out and re-closing it) to make it a more narrow line. Since it is a mature scar and very pliable, the end result should certainly be better than the width of the scar that exists now. The best treatment to do after would be cross-taping to resist the shear and tensional forces across the healing incision. Avoiding strenuous activities, such as exercise on it, for the first 6 to 8 weeks after its revision would be helpful. I do not think that severe physical restriction, however, would make a big difference as stresses across it will continue for years. The use of dermabrasion or laser may be secondarily useful depending upon how the scar outcome.
Dr. Barry Eppley