SLR - October 2022 - Kristel Smith, DPM
Reference: Obi EE. Surgical considerations in skin of colour: minimizing pathological scars. Clin Exp Dermatol. 2022 Aug;47(8):1429-1437. doi: 10.1111/ced.15147. Epub 2022 Jun 21. PMID: 35187688.Reviewed By: Kristel Smith, DPM
Residency Program: Carl T. Hayden VA Medical Center, Phoenix Arizona
Podiatric Relevance: When it comes to performing surgery, podiatric surgeons often forget about the fact that darker skinned patients tend to scar more aggressively than their fair skinned counterparts. The success of the surgery is not only exclusive to the position of the plate and screw. Surgical success also includes the procedural site appealing to the eye of the patient. Not only do surgeons need to be aware of the wound-healing process, they need to actively practice good pre, peri, and post-surgical techniques to minimize scar and keloid formations in darker skinned patients, which is of major concern in these special populations. This paper dives into the wound healing process as well as tips, tricks, advice, and guidelines to aid in the prevention and management of pathological scars for patients with darker skin.
Methods: The authors provided the readers with moreso of a guideline to minimize pathological scarring. Initially, they discuss the process of wound healing and the overall mechanisms for keloid and pathological scar formation. Surgical principles were discussed in depth including obtaining a thorough history of previous wound healing, a thorough physical examination including identifying a patient’s Fitzpatrick skin type and discussing management of expectations during the pre-operative period. Intra-op, authors discussed ideal pre- incision conditions such as avoiding hypothermia, sterile preparation, and novel practices including botox at the incision site. Incision size, placement, and depth, as well as, layered aligned wound closure were highlighted. Authors stressed the importance of close post- operative follow up appointments with appropriate topicals, serial postoperative photography, and excellent wound care tailored to the patient.
Results: Authors developed and compiled a list of take- home learning points that highlight pre operative, intra operative, and post operative management including but not limited to: the appropriate management of expectations, and encouraging patient involvement with each stage of care to avoid loss of follow up, defeat, and post-op dissatisfaction.
Conclusions:
Keloids and pathological scars can have a detrimental impact on self-esteem and discourage patients from consenting to elective and non-elective surgical interventions. It is necessary for providers to take the time to learn and utilize these principles, tips, and tricks when delivering care to this particular patient population. Not only will these providers benefit financially from a larger patient load and excellent reputation amongst the dark-skinned community, patient’s will feel more at ease knowing their provider cares about their beautiful, yet delicate, melanated skin.