Scar treatment

At Institut Ruiz Castilla (IRC), we assess scars following burns, injuries and previous surgery, including our own procedures. Reasons for seeking advice may include pain, itching, tethering, restricted movement, raised scarring or changes in colour.

We consider the scar’s location, extent, age, progression, symptoms and previous treatments. For scars that tighten and restrict movement, we also assess the amount and quality of nearby healthy tissue, its blood supply and its relationship to the skin’s tension lines.

Additional investigations are requested only to answer specific diagnostic or treatment-planning questions.

Not all raised scars behave in the same way. We distinguish scars that remain within the original injury from those that grow beyond its boundaries, while also considering their progression and symptoms to guide treatment.

If a scar is improving and does not cause restricted movement, severe discomfort or significant concern about appearance, we may allow it to mature before considering further treatment.

Tightening that affects function, significant pain or itching, aggressive growth or changes suggestive of a keloid may justify earlier intervention.

Scar care, silicone, compression where appropriate and physiotherapy may form part of treatment. In selected cases, we use topical corticosteroids, corticosteroid injections into the scar or laser treatment.

There is no fixed treatment sequence suitable for every scar. Injections, surgery and radiotherapy each require specific indications. Radiotherapy is reserved for selected situations, particularly certain keloids.

Laser may help address specific features such as texture, stiffness, colour or symptoms. The Institut Ruiz Castilla (IRC) team tailors the technique, intensity and number of sessions to each case. Laser does not completely remove a scar.

We aim to choose the least invasive approach that can provide a meaningful, lasting improvement. The “reconstructive ladder” describes a range of options; it does not mean that every option must be tried before moving to the next.

For extensive scarring, preserving healthy tissue for possible future reconstruction is part of planning.

The choice depends on the scar’s location, its effect on movement and the amount and quality of surrounding healthy tissue.

In some cases, we can rearrange nearby skin using local tissue techniques or flaps—tissue moved while preserving its blood supply—to release the tightened area. In others, we need a skin graft or a staged reconstruction using dermal matrices or tissue expanders.

Not every scar requires the same approach, and not every scar requires surgery. At Institut Ruiz Castilla (IRC), we discuss the alternatives with you, including the improvement we can aim for, any new scars treatment may create and the care you will need afterwards.

We cannot erase a scar or fully control the body’s healing response. The amount and quality of healthy tissue, the location and how the scar develops all influence the improvement achievable.

The timing of revision depends on the underlying problem. Some changes improve over time and no longer require surgery.

Z-plasties and advancement flaps are examples of how nearby skin can be used to release scar tightening. The illustrations explain general principles; the specific technique is tailored to each scar.

In selected cases, rearranging tissue between the thumb and index finger can improve the opening of this space, known as the first web space. Suitability also depends on the deeper structures and rehabilitation needs.

We may prepare healthy tissue using tissue expansion or remove a scar over several operations when its location and the skin’s elasticity allow.

At Institut Ruiz Castilla (IRC), we assess healing after each stage before proceeding. These approaches are not suitable for every case.

Activity restrictions may be minor or require several weeks of protection. The area treated, any skin graft or flap, and the underlying structures involved determine positioning, wound care and movement recommendations.

We coordinate wound protection with rehabilitation medicine and physiotherapy. Movement, stretching and splints are adapted to tissue stability and healing progress.

Scarring of the skin and soft tissues can restrict movement, but tendons, muscles and joints may also have adapted to a longstanding limitation. Releasing the skin does not always restore function immediately.

Rehabilitation and the maturation of internal and external scars continue after surgery. Improvement may be partial and gradual.

Possible complications include delayed wound healing, infection, haematomas, seromas, and partial or complete loss of a skin graft or flap. The risks depend on the individual reconstruction.

Alongside explaining these risks, we discuss how they may be managed: wound care and observation for small affected areas, specific treatments, or further surgery when necessary. The available options depend on the cause, extent and tissues available.

Our nursing team provides wound care as often as needed. The medical team monitors healing and determines whether changes in treatment or further procedures are required.

Once there are no open wounds, pain is controlled and your general health allows, we can plan your return home and arrange continued follow-up, provided this is compatible with the next stages of treatment.

Sun protection, moisturising and scar massage are introduced once the team confirms that the wound has healed sufficiently. Silicone sheets or gel may be recommended depending on the area, the surgical technique and how healing progresses.

Care continues until the scars have matured clinically. Scars do not all mature at the same rate, even in the same person. If a scar becomes raised, firm, itchy or develops unfavourably, the Institut Ruiz Castilla (IRC) team will assess whether specific treatment is needed.

Contact us if you notice increasing pain, persistent bleeding, a rapid change in swelling, spreading redness or increasing warmth, fever, discharge, wound opening or any other change that concerns you. You do not need to decide whether it is a complication: the team will assess it.

Institut Ruiz Castilla (IRC) provides on-call medical support 24 hours a day, seven days a week. Medical and administrative contact numbers are included in your care instructions.

If you experience difficulty breathing, chest pain, fainting or another clear emergency, seek urgent medical attention rather than waiting for a scheduled appointment.