Regular, routine scar assessment will facilitate early identification of a problematic scar. This assessment should include both a subjective and objective assessment. The patient’s own subjective views about the scar, including pain experienced, appearance and sensitivity is important and may influence the patient’s quality of life.
The objective aspects of the scar assessment include its size, shape, colour, texture and pliability.
There are many useful objective scar assessment tools available which offer a means of obtaining quantitative measurements which are important in evaluating treatment efficacy.
Scarring represents the final stage in the normal wound healing process. Clinicians should reassure patients that it is usual to have all or some swelling, slight redness, numbness, itching and sensitivity to touch in the early post-operative months. Clinicians and their patients can help minimise these problems after cardiac surgery by following the patient tip sheet for Managing Scars after Heart Surgery.
The earlier a clinician or patient recognises the signs of abnormal scarring, the better is the likely outcome.
Patients should be advised to seek advice if the scar:
- Is thick and raised
- Is very sensitive and not improving
- Changes in redness, swelling, tenderness or a discharge develops
- Has not settled by 6 months post operatively
Factors that need to be considered prior to electing to treat a scar include:
- Whether the scar is worsening or improving
- The anatomical location of the scar
- Patient’s presenting symptoms
- Presence and/or severity of functional impairment (i.e, does the scar affect mobility)
- Stigma associated with the scar and its impact on the patient’s quality of life
- Likelihood of improvement with treatment