Progression of surgical scars in the hand and wrist over time: A peak in scar-related symptoms

Abstract

We have noted a peak in induration and tenderness around scars with accompanying symptoms 6–8 weeks after most hand operations. The purpose of this study was to characterise this phenomenon. All consecutive patients treated for fractures of the distal radius through a volar scar were prospectively enrolled. Exclusion criteria included: previous injuries of that wrist, no volar scar, open fractures with considerable soft tissue injury, or injuries to the nerve or vessel, or all three. Patients were evaluated every other week for three months after the operation for the following: tightness, the Vancouver scale, oedema, and range of movement in the wrist. Non-linear mixed effects models were used for analysis. Eighteen patients were evaluated. The primary outcomes included a reduction in pliability from 2.1 (0.6) to 0.9 (0.5), and subjective tightness that decreased from 3.6 (1.8) to 1.5 (2.6). Both pliability and subjective tightness showed a parabolic pattern over time, with a peak at 5.10 (95% confidence interval (CI) 4.36 to 5.84) weeks and 4.12 (2.19 to 6.05) weeks, respectively. Mean (SD) active extension increased from 22.5 (11.4)^o at 2 weeks to 45.5 (13.4)^o at 12 weeks. Flexion increased from 19.1 (10.2)^o to 33.0 (14.7)^o. Oedema decreased from 19.4 (2.1) to 17.3 (1.3) cm. The Vancouver scale decreased from 6.0 (1.9) to 3.4 (1.9), and these variables showed a consistent pattern of change over time. Our results support the existence of a peak in scar symptoms, illustrated by a reduction in pliability and an increase in subjective tightness about 4–5 weeks after the operation. Anticipating this healing pattern can aid in tailoring postoperative management of the scar.

Key Words::

• Surgical scar
• peak
• pliability
• tightness