Scar tightness peak following hand and wrist surgery a real phenomenon

SAN FRANCISCO — The peak in scar tightness following surgery in the hand and wrist for distal radius fracture is a legitimate phenomenon and appears to occur around 4 to 6 weeks postoperatively, according to investigators.

John Rodgers, CHT, presented his group’s findings at the Combined Annual Meeting of the American Society for Surgery of the Hand and the American Society of Hand Therapies, here.

“The literature on scar formation and wound healing does not clearly correlate with this phenomenon — the peak reaction time,” Rodgers said. “The significance of looking at peak reaction is that people may know better what to expect during the period of the recovery.”

Evaluations

Rodgers pointed out that while an increase in scar rigidity has been observed as occurring 6 to 8 weeks after surgery of the hand and wrist, “tightness” surrounding the surgical scar tissue has yet to be documented.

He discussed the interim results of a study evaluating the scars of patients who had open reduction and internal fixation of distal radius fractures over a 3-month period.

Patients were evaluated at 2, 6, 8, 10 and 12 weeks postoperatively. Regression and analysis of variance tests were used to determine causality between tightness and objective variables.

According to the study, patients were evaluated for scar thickness, volumetrics, the Vancouver scale for burns, tenderness, subjective tightness in the scar, and range of motion.

Peak of 4 to 6 weeks

In a field of nine patients, there was a peak of scar pliability and subjective tightness at 4 to 6 weeks. Range of motion increased with time, but the Vancouver scale and edema results decreased over time.

Rodgers reported a significant correlation between pliability and the subjective feeling of tightness.

“The phenomenon of peak scar exists, but it is probably different from our impressions,” Rodgers said. “These measures show a peak of 4 to 6 weeks following surgery. Since this time frame and these characteristics do not coincide with skin healing, this may represent a peak in the healing of deeper tssues, such as fascia.”

Determine the existence

Though the presentation was well received, a few audience members expressed their own viewpoints.

“I've done a lot of pediatric hand work, and I can tell you that the peak formation of scar in pediatrics is much, much lower than it is with adults,” one audience member said. “I can also tell you that there is a lot of variability with scar formation that I see. … I think a better way to do it would be trying to figure out which subgroups would do better in which therapy venues.”

Lead author Ronit Wollstein, MD, responded by saying the priority of the study was to verify the existence of the phenomenon.

“I think what we tried to do, first of all, is see if this really exists,” she said. “I think this does occur in carpal tunnel syndrome, releases and other types of scarring; we just chose this because we have a fairly large amount of them and we can see them every 2 weeks.”

Reference:

Wollstein R, Rodgers J, Clavijo J, Carlson L. A peak in scar characteristics during the healing period. Paper HT-03. Presented at the Combined Annual Meeting of the American Society for Surgery of the Hand and the American Society of Hand Therapies. Sept. 3-5, 2009. San Francisco.