Scar Redness in Humans: How Long Does It Persist after Incisional and Excisional Wounding?

RECONSTRUCTIVE

Scar Redness in Humans: How LongDoes It Persist after Incisional andExcisional Wounding?

Jeremy S. Bond, M.R.C.S.(Ed.)

Jonathan A. L. Duncan,M.R.C.S.(Ed.)

Tracey Mason, Ph.D., Cstat.Abdul Sattar, Ph.D.Adam Boanas, B.Sc.

Sharon O’Kane, B.Sc.(Hons.),Ph.D.

Mark W. J. Ferguson, Ph.D.

Manchester, United Kingdom

Background: The natural history of scar redness in humans has never beenformally described, and the point at which normal scar redness fades is un-known.Methods: As part of a randomized, placebo-controlled, clinical trial investigat-ing the effects of various doses of transforming growth factor-�3 on scar quality,the authors observed the process of scar redness and maturation in non–drug-treated incisional and excisional wounds made on the upper inner arms of 103volunteers. Scar photographic images were assessed by a review panel to ascer-tain the month during which redness faded for a particular scar. Scar histologydocumented the level of inflammation and angiogenesis.Results: Scar redness faded at an average of 7 months. Scar redness for incisionsfaded significantly faster than excisions (p � 0.0001, Kruskal-Wallis test), andsignificant differences were also seen between anteriorly and posteriorly placedscars for incisions (p � 0.0008) and excisions (p � 0.0035), respectively. Month12 histologic examination revealed the absence of any ongoing inflammatoryprocesses in all scars.Conclusions: Scar redness fades on average at 7 months. This is influenced bythe wound type and position. The authors advocate the use of the term “ruborperseverans” to describe the physiologic redness of a normal scar as it maturesbeyond the first month, a process that does not involve inflammation. (Plast.Reconstr. Surg. 121: 487, 2008.)

Healing of the acute wound is generally re-garded as following several distinct phasesthat overlap in time, as follows: (1) hemosta-

sis, (2) inflammation, (3) cellular migration and pro-liferation, (4) protein synthesis and wound contrac-tion, and (5) maturation and remodeling.1 Rednessis observed almost immediately after any form ofwounding, whether it be surgical, traumatic, orburn. Typically, this is indicative of the inflammatoryresponse and the vasodilatation of blood vessels andan increase in their permeability. This response alsoresults in such clinical signs as heat, edema, and painwithin the wound site. Neutrophils, activated mac-rophages, and T lymphocytes are recruited to allwounds, where they initiate cellular debridement

and secrete matrix metalloproteinases and specificcytokines such as members of the transforminggrowth factor (TGF)-� family. Macrophages andlymphocytes remain in the wound for approximately7 days and then decrease in number unless a furtherstimulus for inflammation persists. Reepithelializa-tion and revascularization of the wound occur, fol-lowed by myofibroblast-mediated wound contrac-tion and the synthesis of extracellular matrix (e.g.,collagen), which continues for approximately 2 to 4weeks.1–3

Although the resolving wound has been stud-ied in depth, the processes underlying scar re-modeling and maturation have been less widelyinvestigated. This phase is described in the liter-ature as collagen remodeling, whereby thicker fi-

From the University of Manchester and Renovo, Ltd.Received for publication March 27, 2006; accepted August22, 2006.Presented at the Royal College of Surgeons of EdinburghQuincentenary Meeting, in Edinburgh, Scotland, June 29through July 1, 2005.Copyright ©2008 by the American Society of Plastic Surgeons

DOI: 10.1097/01.prs.0000299183.88334.37

Disclosures: Professor Mark W. J. Ferguson andSharon O’Kane are the co-founders and CEO andResearch and Development Director, respectively, ofRenovo, Ltd.

www.PRSJournal.com 487

bers replace the disorganized fine array of fibersand are orientated parallel along lines of skintension.4

Current wound-healing literature contendsthat this process of scar remodeling continues forat least 6 months. An early event is thought to bea decrease in cellularity, particularly between 3and 8 weeks after wounding. This occurs throughthe process of apoptosis, affecting fibroblasts andendothelial cells, and results in flattening of thescar, fading of the initial redness, and regressionof symptoms such as pruritis.5–7 It is believed that,ultimately, the healing process terminates, leavinga relatively avascular and acellular scar.5,8

As part of a clinical trial investigating the ef-fects of TGF-�3 on scarring in humans, we ob-served the process of wound/scar maturation atmonthly intervals for 12 months, noting the timethe scar remained clinically red. Several parame-ters have been defined as being important in theassessment of a scar. These include scar contour,texture, and distortion together with a color mis-match between the scar and normal skin.9–11 Sucha color mismatch can be the result of scar pig-mentation, particularly in burns, or scar redness.However, the natural history of scar redness inhumans (or animals) has never been formally de-scribed in the literature. The time point at whichthe redness of a normal scar fades is unknown,although some clinical observations place it any-where between 3 months and 1 year or longer.5–7

Color mismatch resulting from the redness of ascar is an important assessment parameter for theclinician and of cosmetic concern for the patient.Defining the likely length of the apparent scarredness and its potential implications for scar ap-pearance is an important issue, particularly beforeany surgical procedure.

PATIENTS AND METHODS

VolunteersA total of 103 male volunteers aged 18 to 45

years were recruited to participate in a double-blind, placebo- and standard care–controlled,randomized, clinical trial to assess the scar-improv-ing efficacy of TGF-�3. Written informed consentwas obtained from each individual and ethicalapproval was obtained before the start of the studyby the North Manchester Local Research EthicsCommittee.

Results regarding the reduction and preven-tion of scarring by TGF-�3 are the subject of aseparate publication. This article focuses only onthe aspects of the trial that provide a description

of the natural history of scar redness in non–drug-treated scars (i.e., placebo and control).

Inclusion and Exclusion CriteriaNon–African Caribbean, physically fit individ-

uals (as confirmed by clinical examination, elec-trocardiography, and baseline blood tests) whohad no history of keloid or hypertrophic scar-ring were included. Those taking long-term oralcorticosteroids or nonsteroidal antiinflammatorydrugs were excluded because of the detrimentaleffects of these medications on wound healing.Subjects were included if they had moderate con-sumption of alcohol or cigarettes but not if theytested positive for drugs of abuse. The study com-menced after volunteers underwent a screeningvisit.

ProcedureOn day 0 of the study, each volunteer was

reexamined and baseline blood tests and electro-cardiography were repeated. Two 1-cm lines weremarked using a surgical marker on each arm.These marks were placed exactly 3 cm apart on theinner surface of the upper arm, with one placedanterior and one posterior to the longitudinal axisof the arm. Local anesthesia was obtained usingplain 1% lignocaine. After local anesthesia, eachsite received an intradermal injection of TGF-�3,placebo, or nothing (standard care). Both armswere then cleaned with antiseptic and prepared withsurgical drapes. After ensuring anesthesia, two 1-cmincisions were created over the marked areas oneach arm. The incisions were made through theepidermis and dermis, stopping at the subcutaneousfatty layer. Hemostasis was achieved following directpressure to each wound site. Incisional wounds wereclosed using a standard configuration and numberof Steri-Strips (3M, St. Paul, Minn.) secured to thesurrounding unwounded skin by Mastisol adhesive(Ferndale Laboratories, Inc., Ferndale, Mich.). Allincisional wounds were then covered with water-proof dressings.

On day 3, the two incisions on one randomlyselected arm (arm 1) were excised with a 2-mmmargin using an ellipse and then closed usingnonabsorbable interrupted Prolene sutures (Ethi-con, Inc., Somerville, N.J.). Steri-Strips on arm 2remained in place for 2 weeks before removal.

Volunteers then returned at monthly intervals(�10 days) for 1 year for a safety and tolerationassessment of all resulting scars and film and dig-ital photographs. Both film and digital photo-graphs were taken under standardized conditions

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with fixed manual systems whose lighting, expo-sure, and distance from the subject were set asconstant. Specifically, the digital camera waswhite-balanced for its light source and the result-ant images standardized using known tonal steps.Photographs also included a standard measure-ment and color scale. At month 12, arm 2 scarswere anesthetized and excised using the same pro-cedure as that used for arm 1.

Assessment of Scar Redness

Internal Panel Review of PhotographsPhotographic images were reviewed by six con-

sistent members of an internal panel consistingprimarily of scientists and clinicians with a back-ground in wound healing and antiscarring re-

search. They viewed, in a blinded fashion, all thescar images per individual and made observationsrelated to scar color. One of the key endpointobservations was identifying, by consensus, themonth at which the redness of each scar had fadedor whether it persisted after month 12. Fading wasdefined as either no redness or when the rednesshad diminished to an insignificant level and pla-teaued, as displayed in Figures 1 and 2.

Histologic AnalysisAfter excision of arm 2 scars at month 12,

specimens were fixed immediately in 10% (vol-ume/volume) phosphate-buffered formol salinefor 48 hours. The specimens were processed toproduce slides stained with Masson’s trichromeand hematoxin and eosin to allow histologic anal-

Fig. 1. Photomontage of excisional scars of two subjects showing the natural history of scar redness resulting from excisionalwounding. (Above) In subject A, the redness faded at 9 months; (below) in subject B, the scar was still red at 12 months. The differencebetween anteriorly (subject A) and posteriorly (subject B) placed scars can be observed.

Fig. 2. Photomontage of incisional scars of two subjects showing the natural history of scar redness resulting from incisionalwounding. (Above) In subject A (anterior position), the redness faded at 9 months; (below) in subject B (posterior position), the scarwas still red at 12 months. The variation in redness resolution in scars can be appreciated.

Volume 121, Number 2 • Scar Redness

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ysis of inflammation and angiogenesis. Assessmentwas made by estimating the level of inflammation,together with the size and number of blood ves-sels. The scar sections were viewed under a con-stant magnification, and each parameter was as-sessed as being at either a higher, lower, or similarlevel compared to that found in the adjacent nor-mal dermis of the specimen. These assessmentswere performed by a scoring panel composed ofexperienced wound-healing histologists blindedto treatment. The histologic review of arm 1 (day3) excised scars is not described in this article, asit is irrelevant to the topic under analysis.

Statistical AnalysisOrdered categorical methods were used to test

the null hypothesis of no row-by-column interac-tion. To consider incisional and excisional or an-terior and posterior comparisons, the Kruskal-Wallis test for singly ordered categorical data wasapplied. With regard to the histology, as the mea-sures used in the study were classed as “similar tonormal dermis” or “higher than normal dermis”the Jonckheere-Terpstra test for doubly orderedcontingency tables was used.

RESULTSData from the photographic review by the in-

ternal panel relating to the point at which theyobserved scar redness fading were collated andanalyzed. A total of 412 incisional wounds werecreated in the study population of 103 volunteers,of which 171 were placebo or control in origin.From these, 4296 scar images were assessed by theinternal panel. Monthly safety and toleration as-sessments revealed no evidence of persistent

wound infection during the study involving any ofthe wounds or scars, and there was no incidenceof hypertrophic or keloid scar development. Onlythe results of the non–drug-treated scars were con-sidered.

All ScarsFigure 3 and Table 1 show the number of scars

fading per month for all non–drug-treated (i.e.,placebo and standard care) wounds. The largestproportion of scars faded at 7 months (25.7 per-cent), and the average was 7.3 months. Indeed, bymonth 7, 53.8 percent of all scars had faded. Itshould be noted that 15.8 percent of scars re-mained red until some point after the 12-monthstudy window.

Excisional versus Incisional ScarsWounds from arm 1 of the volunteer were

excised after 3 days and redosed with the sametreatment as day 0, whereas scars from arm 2 wereexcised at 12 months. Excisional scar rednessfaded on average at 7.9 months as compared with6.8 months for incisional scars. Figure 4 and Table1 show the percentages and number of scars re-maining red for excisions and incisions permonth, with incisional scars clearly fading faster(p � 0.0001, Kruskal-Wallis test). This clinical dif-ference in redness resolution between differentscar types is illustrated in Figures 1 and 2.

Spectrum of Normal HealingFigure 4 shows the percentage of excisional

and incisional scars fading at each month over thecourse of 1 year; 10.7 percent of incisional scars

Fig. 3. Bar chart demonstrating the number of scars fading per month. C, continuous (i.e., scars that were still redat the month 12 visit).


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faded within the first 4 months, with 65.5 percentfading between months 5 and 8. By contrast, only50.6 percent of excisional scars had faded bymonth 8, with 26.4 percent still red at 1 year (Table2). Figures 1 and 2 highlight the variations in scarredness resolution between similar subjects andwounds.

Positional DifferencesThe mean month at which the scar redness

faded was also related to the position of the scar oneach arm. For excisions, the mean month for scarsto fade in the anterior position was 7.5 months, asopposed to 8 months for the posterior position. Forincisions, anteriorly placed scars displayed a mean of6.3 months for the redness to fade compared with7.1 months for those placed posteriorly. Figures 5

and 6 show the percentage of scars remaining redper month for excisions and incisions with respect toposition and suggest that anteriorly placed scars fadefaster in both wound types (p � 0.0035 and p �0.0008, respectively, Kruskal-Wallis test). This obser-vation appeared more marked for excisional as com-pared with incisional scars, as can be appreciated inFigure 1.

Scar HistologyArm 1 scars were excised at day 3 (for early

time-point histology, e.g., reepithelialization, notconsidered here), whereas arm 2 scars were ex-cised at month 12 of the study. Analysis of all arm2 (late time point) scars revealed a level of inflam-mation similar to normal dermis in all samples:83.8 percent displayed similar sized blood vesselsand 41.3 percent a similar number of blood vessels

Table 1. Total Number of Scars and Numbers ofExcisional and Incisional Scars Fading per Month

Month

No. ofScars Fadingper Month

No. ofExcisional

Scars Fadingper Month

No. ofIncisional

Scars Fadingper Month

3 4 0 44 5 0 55 11 3 86 28 8 207 44 21 238 16 12 49 15 8 7

10 10 6 411 5 2 312 6 4 2Continuous 27 23 4Total 171 87 84

Fig. 4. Bar chart demonstrating the percentage of scars remaining red per month with respect to wound type(excisions, n � 87; incisions, n � 84).

Table 2. Percentage of Excisional and IncisionalScars Remaining Red per Month

Month

ExcisionalScars Remaining

Red per Month (%)

IncisionalScars Remaining

Red per Month (%)

2 100 1003 100 954 100 895 96.4 796 86.8 567 61.5 288 47 239 37.4 15

10 30.2 1011 27.8 612 23 4


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as normal dermis at month 12. The proportions ofscars that faded at each month assessed as havingeither a higher or similar number or size of bloodvessels histologically at month 12 compared withnormal dermis are shown in Figures 7 and 8. Fig-ures 9 and 10 display these data for a given rangeof months and show the rise in the proportion ofscars with a higher number (p � 0.0136, Jonck-heere-Terpstra test) and larger size of blood ves-sels (p � 0.0208, Jonckheere-Terpstra test) thannormal dermis, as the time taken for the rednessto fade increases.

DISCUSSIONScar redness following wounding is not an un-

familiar observation in clinical practice.12 There-

fore, despite the fact that redness is a feature ofnormal scars, little evidence exists within the cur-rent literature to suggest how long this phenom-enon lasts, whether it persists as long for all scars,and what factors contribute to it. To our knowl-edge, this is the first study to chart the longitudinalclinical progress of redness in normal scars.

Our results demonstrate that in relation toscar redness resulting from the processes of nor-mal wound healing, the majority and indeed meannumber of scars fade at or approximately at 7months. We have shown furthermore that a con-siderable proportion of scars (15.8 percent) dis-play persistent redness at 12 months, in the ab-sence of features suggestive of hypertrophic orkeloid scarring, as can be seen in Figures 1 and 2.

Fig. 5. Bar chart demonstrating the percentage of excisional scars remaining red per month with respect to position(anterior, n � 36; posterior, n � 51).

Fig. 6. Bar chart demonstrating the percentage of incisional scars remaining red per month compared with normaldermis remaining red per month with respect to position (anterior, n � 48; posterior, n � 36).


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This appears to contrast with the established viewthat in the majority of “normal scars,” redness willfade at some point on or before 1 year afterwounding.5–7

Looking more closely at the differing woundtypes, namely, incisions and excisions, we also seea difference in the pattern of scar redness reso-lution (Figs. 1 and 2). Scars resulting from exci-sional wounding (arm 1) invariably faded latercompared with those resulting from incisionalwounding (arm 2) (Fig. 4), with a larger percent-age of excisional scars (22.9 percent) still red at 12

months. The reason for this observation is notentirely clear but may be related to a number ofparameters, including the more extensive traumaof the excision itself compared with an incision(despite the fact that both margins were suturedclosed) and the relative tension across the woundafter closure.13–15

Despite the stringent inclusion and exclusioncriteria required for this study, the uniform pat-tern and position of wounding, and the regularscar review visits, marked variation was observed inthe fading of redness between individuals. By ob-

Fig. 7. Chart demonstrating the proportion of incisional scars (n � 80) assessed with either a similar or highernumber of blood vessels compared with normal dermis at 12 months versus the month at which scar redness faded.C, scars that were still red at month 12 visit.

Fig. 8. Chart demonstrating the proportion of incisional scars (n � 80) assessed with either similar or larger sizes ofblood vessels compared with normal dermis at 12 months versus month at which redness faded. C, scars that werestill red at month 12 visit.


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serving the pattern of redness across our study(Table 1), it can be appreciated that althoughmost excisional and incisional scars fade betweenmonths 5 and 8, the pattern is indeed variable,with significant numbers taking less or more timeto fade. This indicates subtle differences in theprocess of healing in a similar group of woundsmade in similar locations in clinically healthy sim-ilar individuals. The photographic images in Fig-ures 1 and 2 relating to excisional and incisionalscars clearly demonstrate this observation. Al-

though not encountered in this study, hypertro-phic scarring may represent the extreme end ofthis variation, the genetic and cellular basis ofwhich will be investigated in future studies.

Langer showed that the direction in which awound is made in different parts of the body af-fects the degree of tension acting on the wound.15

Our results, although not achieving statistical sig-nificance, intimate that even short distances be-tween wounds (3 cm) can influence the time pe-riod for the resultant scar to fade. In our study of

Fig. 9. Chart demonstrating the proportion of incisional scars (n � 80) assessed with either asimilar or higher number of blood vessels compared with normal dermis at 12 months versusthe range of months over which scar redness faded.

Fig. 10. Chart demonstrating the proportion of incisional scars (n � 80) assessed witheither similar or larger sizes of blood vessels compared with normal dermis at 12 monthsversus the range of months over which redness faded.


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wounds placed on the upper inner aspect of thearm, anteriorly placed incisional and excisionalscars appear to fade faster than those in a moreposterior position (Fig. 1). The mechanisms un-derlying this observation are not clear, as it wouldbe logical to presume that both sites displayed asimilar pattern of vasculature and degree of ten-sion when closed.

Histologic analysis of non–drug-treated inci-sional scars at 12 months revealed no evidence ofany ongoing inflammatory process. With regard toblood vessels, 83.8 percent of scars had blood ves-sels of a size similar to normal dermis and 58.8percent had a higher number of blood vessels thanfound in normal dermis. Figures 7 through 10demonstrate how the clinical appearance of inci-sional scars correlates with the underlying histol-ogy. When plotted against a range of months whenthe redness fades clinically, as in Figure 9, theproportion of scars with a higher number of bloodvessels rises steadily from 22.2 percent for whenredness fades at months 0 to 4, to 86.7 percent forscars that fade at months 9 to 12, to 100 percentfor scars still red after 12 months. Our resultsindicate that the longer scar redness takes to fadeclinically, the more likely the scar is to contain ahigher number and larger size of blood vessels atmonth 12. Persisting scar redness is therefore notattributable to ongoing inflammation or infec-tion, and the relatively normal size of blood vesselsseen within the scar would suggest that it is not theresult of abnormal vasomotor tone within the ves-sel wall. Rather, these results appear to agree withprevious studies regarding the persistence ofblood vessels within mature scars and suggest thatscar redness may be related to the overall numberof blood vessels within the scar.8 More definitivestudies incorporating an assessment of function-ality and a vessel count using an appropriate im-munohistochemical stain are required to confirmthis fully. A more accurate assessment of vesselnumber should also include the relative position(superficial or deep) within the scar of the bloodvessels, as macroscopic scar redness could poten-tially be explained by a larger proportion of su-perficially placed vessels.

Erythema and redness can be confusing andmisleading descriptive terms when applied to thenatural history of scar redness fading, as they implythe presence of an inflammatory or infective pro-cess. We suggest that the term scar erythema bereserved for use where there is evidence of un-derlying inflammation and to denote the rednessof a normal scar for the first month after wound-ing, when the normal inflammatory response is

present. By contrast, we advocate use of the term“rubor perseverans” to describe the physiologicredness of a normal scar as it matures beyond thefirst month, a process that does not involve in-flammation.

The strict inclusion and exclusion criteria re-quired for this study limited the volunteer popu-lation and as such did not consider scar rednessresolution in the elderly or in women. Indeed, thedecision of the photographic review panel couldhave been corroborated by the use of a device suchas a chromometer or spectrophotometer used asan aid in the determination of redness resolutionitself.10 This is currently under investigation in aseparate study. Although it is acknowledged thatthis study cannot be definitive when consideringthe natural history of scar redness in general, par-ticularly given the limited number of scar typesand body sites, it does give an insight into theprocess of redness resolution, albeit in a uniformgroup of scars.

CONCLUSIONSOur results demonstrate that, on average,

most scars fade at or approximately 7 months afterwounding. However, significant numbers of scars,particularly as a result of excisional wounds, re-main red at 12 months. This is of particular im-portance in the presurgical counseling of patientswith regard to likely scar appearance and timescale for redness resolution. Furthermore, the de-gree and persistence of scar redness depend onthe nature of the wound and its position on thearm despite relatively small distances between ad-jacent wounds. Scar redness is not the result ofpersisting inflammation or infection when exam-ined histologically. Therefore, the term rubor per-severans is a more appropriate expression whendescribing the natural redness of a normal non-inflamed scar following the first month afterwounding.

Mark W. J. Ferguson, Ph.D.Faculty of Life Sciences

University of Manchester3.239 Stopford Building

Oxford RoadManchester M13 9PT, United Kingdom

[email protected]

REFERENCES1. Monaco, J. L., and Lawrence, T. W. Acute wound healing: An

overview. Clin. Plast. Surg. 30: 1, 2003.2. Singer, M. D., and Clark, R. A. F. Cutaneous wound healing.

N. Engl. J. Med. 341: 738, 1999.3. Hart, J. Inflammation 1: Its role in the healing of acute

wounds. J. Wound Care 11: 205, 2002.


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4. Cherry, G. W., Hughes, M. A., Ferguson, M. W. J., and Leaper,D. J. Wound healing. In P. J. Morris and W. C. Wood (Eds.),Oxford Textbook of Surgery, Vol. 1, 2nd Ed. New York: OxfordUniversity Press, 2000. P. 131.

5. Dierickx, C., Goldman, M. P., and Fitzpatrick, R. E. Lasertreatment of erythematous/hypertrophic and pigmentedscars in 26 patients. Plast. Reconstr. Surg. 95: 84, 1993.

6. Marks, M. W., and Marks, C. Wound management. In Fun-damentals of Plastic Surgery, 1st Ed. Philadelphia: Saunders,1997. P. 3.

7. McGregor, A. D., and McGregor, I. A. Fundamental Techniquesin Plastic Surgery and Their Applications, 10th Ed. New York:Churchill Livingstone, 2000.

8. Brown, N. J., Smyth, E. D. A., Cross, S. S., and Reed, M. W.R. Angiogenesis induction and regression in human surgicalwounds. Wound Repair Regen. 10: 245, 2002.

9. Beausang, E., Floyd, H., Dunn, K. W., Orton, C. I., andFerguson, M. J. W. A new quantitative scale for clinical scarassessment. Plast. Reconstr. Surg. 102: 1954, 1998.

10. Van Zuijlen, P. P. M., Angeles, A. P., Kreis, R. W., Bros, K. E.,and Middelkoop, E. Scar assessment: Implications for cur-rent research. Plast. Reconstr. Surg. 109: 1108, 2001.

11. McOwan, C. G., Macdermid, J. C., and Wilton, J. Outcomemeasures for evaluation of scar: A literature review. J. HandTher. 14: 77, 2001.

12. Rahban, S. R., and Garner, W. L. Fibroproliferative scars.Clin. Plast. Surg. 30: 77, 2003.

13. Sommerlad, B. C., and Creasey, J. M. The stretched scar:A clinical and histological study. Br. J. Plast. Surg. 31: 34,1978.

14. Burgess, L. P., Morin, G. V., Rand, M., Vossoughi, J., andHollinger, J. O. Relationship of wound closing tension toscar width in rats. Arch. Otolaryngol. Head Neck Surg. 116:798, 1990.

15. Cacou, C., Anderson, J. M., and Muir, I. F. K. Measurementof closing force of surgical wounds and relation to theappearance of resultant scars. Med. Biol. Eng. Comput. 32:638, 1994.

PRS is ‘‘Media Choice” in Medical Marketing and Media MagazineDavid C. Watts, M.D., medical director of the Plastic and Cosmetic Surgery Institute of Vineland, New Jersey,selected Plastic and Reconstructive Surgery as his Media Choice in the August 2007 issue of Medical Marketingand Media magazine.

“PRS is the gold standard of journals for plastic surgery as the official journal of the American Society of PlasticSurgeons. The ‘White Journal,’ as it is known, is sectioned to address surgical areas such as breast, experi-mental, reconstructive, hand/peripheral nerve, pediatric/craniofacial, and cosmetic. PRS provides the latestoperative techniques along with the basic science that supports advances occurring in the field. A discussionoften accompanies articles to provide an opportunity to critique the article and make comments. Each issuecontains an online CME article with questions that are pertinent and also provide CME credit. I considerPRS a ‘must read’ for any practicing plastic surgeon.”


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Scar Redness in Humans: How Long Does It Persist after Incisional and Excisional Wounding?

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