Improving Scar Quality: A Prospective Clinical Study

Atiyeh BS, et al. Anesthetic Plastic Surgery 2002; 26: 470-476
By this present study, the prophylactic effect of MEBO application on improving the cosmetic appearance and preventing pathologic scar formation in facial wounds healed by primary intention is well pronounced during the first three months following wounding.  The ointment was applied immediately postoperatively during the inflammatory phase of wound healing.  Application continued only through the proliferative fibroplastic phase.  Silicone sheeting, on the other hand, is effective only when applied to already developing and remodeling scar tissue.  It has no effect when applied during the early inflammatory phase of wound healing.  The action of MEBO on scar formation is probably different from that of silicone.  Silicone application induces changes in scar milieu reducing the non-immunological activation of mast cells, thus reducing scar edema and tissue activity that in turn induce a flattening of the scar.  On the other hand, marked early reduction in the degree of hyperemia and good color match exhibited by the present study and demonstrated in already reported studies about MEBO action on healing of partial thickness wounds carry striking similarities with the effect of pulse dye laser on the microcirculation when applied for prophylactic scar treatment.
As it is now widely accepted that vascular overgrowth is the cornerstone of scar hypertrophy, a decrease in vascular activity with consequent decrease in hyperemia may be the most logical modality nowadays in preventing unfavorable scar formation.  Definitely, this can be achieved by selective photothermolysis using the pulse dye laser.  A much simpler alternative would be to increase tissue moisture which has a comparable demonstrable effect by decreasing capillary activity, reducing hyperemia, and reducing collagen deposition.  MEBO application appears to be a much simpler alternative to pulse dye laser.  Moreover, contrary to silicone, it is effective as a prophylactic scar treatment modality.  A comparative study of pulse dye laser, silicone, and MEBOapplication in prophylactic scar treatment is in order.