Actualización en el manejo de la cicatrización en la cirugía pediátrica: ¿Qué debemos de tener en cuenta?: Una revisión narrativa

Update on wound management in pediatric surgery: ¿What should we keep in mind?: A narrative review

Resumen

Scarring in pediatric patients is a dynamic process influenced by local, systemic, and contextual factors. Greater lesion depth and size, younger age, darker skin phototypes, and delayed epithelialization are associated with a higher risk of hypertrophic scars and keloids. This integrative narrative review (2005–2025) analyzed preventive and therapeutic strategies ranging from surgical planning to the management of mature and pathological scars. Prevention begins with incisions aligned to relaxed skin tension lines, layered closure using absorbable sutures, and early epithelialization. For immature scars, topical silicone and scar massage are cost-effective interventions supported by robust evidence, while laser therapies (pulsed dye laser and fractional CO₂) provide additional benefits when applied early. Management of mature scars includes retinoids, chemical peels, fractional lasers, dermabrasion, microdermabrasion, and autologous fat grafting. Hypertrophic and keloid scars are primarily treated with pressure therapy, intralesional corticosteroids, and laser modalities, reserving surgical excision and intralesional cryotherapy for refractory cases. In conclusion, a stepwise, individualized approach grounded in scar chronobiology optimizes aesthetic and functional outcomes in pediatric surgery, underscoring early prevention and long-term follow-up as essential components to minimize pathological scarring and its psychosocial impact.