care. Maximal scar contraction begins to occur roughly 10-14 days after the incision is made, which is approximately the time when we began to apply SKN2017B in our treatment group.27 Our rationale was to begin applying the topical cream at the point when maximal scar tissue develops. Our study provides support for the early use of a topical scar cream, since we observed a reduction in the need for intralesional wound modulation at the 1-month postoperative visit in those treated with SKN2017B.Additionally, subjects treated with SKN2017B were less likely to develop postoperative cicatricial and hypertrophic scarring, which subsequently reduced the need for intralesional injection of triamcinolone and 5-FU by nearly 50% in the patients. Furthermore, there was a decreased need for repeated intralesional wound modulation for the SKN2017B group (only 6.4% of eyelids) in comparison to the no treatment group, in which nearly 27.6% of eyelids required at least 2 injection treatments. Therefore, surgeons that pay particular attention to the quality of scars may benefit from using a siliconecream based scar cream that has proven effective in wound healing. Furthermore, patients that are not able to follow-up as frequently as desired due to various situations (long-distancetravel, employment reasons) may benefit from a topical scar cream that can reduce the likelihood of post incisional cicatricialor hypertrophic changes.Despite a large assortment of topical scar creams on the market, few have demonstrated the capacity to effectively reduce scarring. Silicone cream, the foundational matrix of SKN2017B, has a reliable history as a safe method for reducing scars.19,28 A recent double-blinded, multi-center clinical trial demonstrated SKN2017B to be superior to silicone cream for improving the appearance of various scars that were evaluated, including eyelids.26 Nevertheless, in this particular study, we cannot determine which particular ingredient (i.e., silicone cream or growthfactors) played a dominant role in wound healing. We suspect that it was a combination of the growth factors and other ingredients synergistically working together within a silicone cream matrix to allow for the results seen in this study.Although there is a reduction in post-operative hypertrophic and cicatricial changes with topical application of SKN2017B, undesirable scars can still occur. Of those that were treated with SKN2017B, there was still a need for intralesional wound modulation in 22.9% of the eyelids based on our Vancouver Scar Study Scale inclusion criteria. In cases where eyelid scars do not heal well despite intralesional wound modulation, ablative resurfacing, microneedling, and even scar revision in severe cases may need to be considered.16,17,30-32There are several limitations to this study. The incidence of intralesional wound modulation varies among surgeons, whereas some may inject incisions more often than others, and that the reader should not generalize the incidence of intralesional injectionsof triamcinolone and 5-FU performed in this study to the general population of surgeons performing eyelid surgery. We attempted to rid as many biases in our study by performing chart review from a single-surgeon case series of patients that underwent a similar surgical technique and type of wound closure by the same individual, thus establishing an ideal internal consistency. This greatly reduces the possibility of a confounding variable (i.e., surgical technique, mastery, etc.) influencing the results. Furthermore, the senior author objectively evaluated the quality of the scar using the modified Vancouver Scar Study Scale, and an intralesional injection was performed to selected areas of the scars in areas that were Grade 2 or higher in “Pliability” and “Height.” In our study, we did not evaluate for other issues that can result from scarring, such as hyperpigmentation, prolonged vascularity, milia, and standing cone deformities. These should be evaluated in future studies. Future studies should also evaluate the optimal suture type and wound closure technique through a well-designed, prospective studies.
Christopher I. Zoumalan MD FACS is a consultant for Allergan, Irvine, CA and owns stock and is the scientific advisor for MD Medical Designs, Inc., Los Angeles, CA, manufacturer of the scar creams studied in this trial. Brandon D. Kalasho BA and Robin Kikuchi have nothing to disclose.
We thank Cristina Luna for research coordinating support.
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