Surgical Scar Management and Outcomes in Racial/Ethnic Minorities: A Systematic Review

Background: Patients with darker skin tend to experience an increased prevalence of adverse surgical scarring and poorer treatment response in comparison to White patients. Ethnic and racial factors play a role in overall surgical scar outcomes because they predispose darker-skinned individuals to sequelae such as scar hypertrophy, keloid formation, and an overall negative psychosocial impact. This systematic review will summarize existing literature on surgical scar outcomes and management in minority patients and will highlight gaps in the medical literature. Methods: The search was conducted using PubMed, Embase, Scopus, and Cochrane Library to identify relevant articles. All articles went through title and abstract screening, followed by full-text review. Results: Of 1235 articles, 40 met eligibility criteria. Following the full-text review, 10 articles were included. In 5 of the 10 studies, patients were characterized as having Fitzpatrick skin types II–V. Five studies utilized laser techniques, and the remaining 3 studies utilized silicone sheet, topical silicone, and surgery. The Vancouver Scar Scale was the most utilized assessment tool. The two studies that evaluated fractional CO 2 laser interventions using the Vancouver Scar Scale showed improvement in scar outcomes and overall patient satisfaction. Conclusions: Laser interventions were the most utilized and show promise for improving scar management outcomes in ethnic patients, though there is little work highlighting treatment decision-making in scar management. This review emphasizes the need for increased research focused on scar management interventions and comprehensive protocols to address scar management in plastic surgery for patients with darker skin.