Post-operative scar management - the use of paper tape to prevent hypertrophic scarring in surgical incisions

Background:  

          Hypertrophic scarring is a frequent and undesirable complication of surgical incision. It has been documented to occur in approximately 64% of scars following surgery. The prevention of hypertrophic scar formation has been shown to be unrelated to surgical technique or the type of suture material used. Rather, it is how a scar is managed postoperatively which influences its cosmetic outcome. After suture removal, scars are susceptible to skin tension, which may be the trigger for hypertrophic scarring. Paper tape to support the scar may reduce multi-directional forces and prevent hypertrophic scar formation.  

Method: 

          Seventy patients who had undergone caesarean section at the Royal Brisbane and Women's Hospital were randomised to treatment and control groups. Patients in the control group received no post-operative intervention. Patients in the treatment group applied paper tape to their scars for 12 weeks. Scars were assessed at 6 weeks, 12 weeks and 6 months post-surgery using ultrasound to measure the scar's intra-dermal width and height. Scars were also assessed for hypertrophy using the international clinical recommendations.  

Results:  

          The use of paper tape significantly decreased scar volume by a mean of 0.16 cm³, (95% CI: 0.00, 0.29 cm³). At 12 weeks post-surgery 41% of patients in the control group developed hypertrophic scars compared to none in the treatment group (Fisher's Exact test, p= .003). The odds of developing a hypertrophic scar were 13.6 times greater in the control compared to the treatment group (95% posterior interval: 3.6, 66.9). Conclusion: Given that in the treatment group one patient developed a hypertrophic scar and four patients developed stretched scars only after the tape was removed, this suggests that tension acting on a scar is the trigger for hypertrophic scarring. Paper tape is likely to be an effective modality for the prevention of hypertrophic scarring through its ability to eliminate scar tension.  

Conclusion: 

          Given that in the treatment group one patient developed a hypertrophic scar and four patients developed stretched scars only after the tape was removed, this suggests that tension acting on a scar is the trigger for hypertrophic scarring. Paper tape is likely to be an effective modality for the prevention of hypertrophic scarring through its ability to eliminate scar tension.