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Presentation

Top 10 Tips for Pediatric Skin Surgery and Scar Prevention

Description

The speaker, a Mohs surgeon and procedural dermatologist, explains that pediatric skin surgery should be treated as a distinct practice because children are not small adults: they behave differently, need age-appropriate preparation, and heal differently. The talk presents 10 tips for smoother operations and better scar outcomes. Key advice includes thorough preoperative planning with the child and family, using topical anesthetic and careful local anesthesia techniques to reduce anxiety and pain, and planning the surgery with future growth in mind by aligning incisions with relaxed skin tension lines. The speaker emphasizes operating early when lesions are growing, symptomatic, or diagnostically uncertain, but waiting when lesions are stable or likely to regress. To reduce scarring, they recommend minimizing incision length, using techniques like incise-and-squeeze or purse-string closure when appropriate, handling delicate pediatric tissues gently, minimizing tension with undermining and layered closure, considering staged excisions for large lesions, and using absorbable sutures when suture removal may be traumatic. Postoperatively, wounds should be well protected because children often pick at dressings and sutures, and children should be rewarded at the end of the procedure. The speaker also discusses scar hypertrophy, noting that children have increased fibroblast activity, more collagen deposition, and a longer remodeling phase, which can lead to thickening scars over time. Scar prevention strategies include activity restriction, silicone gel or sheets, massage, laser or microneedling when appropriate, and steroids for thickening scars, with some families choosing observation and later revision if needed.

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Conclusions

Pediatric skin surgery should be treated as a distinct practice from adult surgery because children differ in behavior, skin properties, healing, and scar formation.
Thorough preoperative preparation, age-appropriate communication, and planning for anesthesia and positioning are key to smoother procedures in children.
Topical anesthetic and gentle, well-disguised local anesthesia with distraction techniques can substantially improve the child’s tolerance of surgery.
Operative timing should be individualized: operate early for uncertain, growing, symptomatic, or psychosocially impactful lesions, but consider waiting for stable, asymptomatic, or potentially regressing lesions.
Scars in children can widen and thicken as they grow, so incisions should be planned along relaxed skin tension lines and with future growth in mind.
Minimizing incision size, including techniques like incise-and-squeeze or purse-string closure, can reduce scar length and procedure time.
Children’s thin, elastic skin requires careful tissue handling and avoidance of excessive cautery to support optimal healing.
Reducing closure tension with adequate undermining, layered repair, dermal sutures, tape reinforcement, or staged excisions helps improve cosmetic outcomes.
Because children are prone to picking at wounds and resuming activity too soon, postoperative wound protection and downtime are important for healing.
Positive reinforcement or rewards at the end of the procedure can improve the overall experience and cooperation for pediatric patients.
Scar hypertrophy is common enough in children that families should be counseled in advance that even well-performed surgery may later produce thicker scars.
Early scar prevention and management—including activity reduction, silicone, massage, sun protection, and selected interventions such as steroids or laser—may help limit hypertrophy over time.

Koo & Jung (2023). Advances in Pediatric Surgery. 29. 9. 10.13029/aps.2023.29.1.9.#10.13029/aps.2023.29.1.9