Orthopaedic surgery is generally a discipline where functional restoration and pain relief take precedence over esthetics. However, all practicing surgeons know that how incisions appear is important to many patients and their families. This is especially true in pediatric orthopaedics, where parents feel a responsibility to limit any adverse experiences their child may have.
In the August 17, 2016 edition of The Journal, Davids et al. provide our community with an important contribution regarding some basic principles of scar management in children—in this case, kids with cerebral palsy who had a second surgery to remove an implant. The take-home message is that scars that are acceptably thin with minimal discoloration are safe to treat and do well cosmetically with a repeat incision through the original scar. Scars that are broad and/or discolored basically end up with the same appearance when the implant is removed through excision (a second incision about the margins of the first incision) and layer closure.
This field is ripe for further investigation, and careful attention to methodology will be very important. Interventions that deserve additional study include topical and intralesional treatments for healing incisions, the impact of immobilization on the quality of scars below the knee, and the effects on scars of limited weight bearing, to name a few. Similar investigations in select groups of adults with scars about the shoulder, knee, and ankle will also be welcome additions to this objective evaluation of surgical-incision outcomes by Davids et al.
Marc Swiontkowski, MD