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Scar revision surgery – Information for GPs

Referral criteria / commissioning position

NHS Scarborough and Ryedale CCG (SRCCG) will routinely commission scar revision surgery only in patients where ALL of the following criteria apply:

  1. The scarring is causing adverse physical consequences (due to contraction, tethering or recurrent breakdown); significant functional impairment (for example obstruction of orifice or vision); bleeding or suspicion of malignancy; AND
  2. Where clinically appropriate, proactive conservative therapies (steroid injections, vitamin E creams, silicone therapy, pressure garments, medication or massage) aimed at arresting the development of adverse, keloid or hypertrophic scarring have been tried but have not been effective; AND
  3. At least 18 months of the natural healing process has passed.

Patients who are not eligible for treatment under this policy may be considered on an individual basis where their GP or consultant believes exceptional circumstances exist that warrant deviation from the rule of this policy. Individual cases will be reviewed as per the CCG policy.

NHS SRCCG will not routinely commission scar therapy or surgery, including skin resurfacing, in secondary care for any of the categories listed below:

  • Hypertrophic or keloid scars that are not causing adverse consequences or functional impairments (e.g. keloid scarring after ear piercing)
  • Scarring / ulceration from chronic tattoo breakdowns
  • Post-acne scarring
  • Scar treatment for skin rejuvenation or other cosmetic purposes

In these cases, individual requests for scar treatment / revision must come from primary care, and if approved via the IFR process this would allow referral to secondary care to assess and/or treat as clinically appropriate, including surgery.

All IFR requests for scar revision must include details of the cause, appearance, size and location of the scarring (clinical photographs may help); the outcome of any previous conservative therapies and the extent and nature of the adverse effects that the scarring is causing to the individual.

Investigations prior to referral

None

Information to include in referral letter

  • Details of how the patient meets the above criteria OR demonstrates clinical exceptionality
  • Impact on activities of daily living
  • Treatments and interventions tried including the results
  • Drug history (prescribed and non-prescribed)
  • Relevant past medical/surgical history
  • Current regular medication
  • BMI

References

  1. Commissioning Guide - Referrals and Guidelines in Plastic Surgery (NHS Modernisation

Agency). http://www.bapras.org.uk/docs/default-source/commissioning-and-policy/information-for-commissioners-of-plastic-surgery-services.pdf?sfvrsn=2

  1. Juckett G, Hartman-Adams H; Management of keloids and hypertrophic scars. Am Fam

Physician. 2009 Aug 1;80 (3):253-60. http://www.aafp.org/afp/2009/0801/p253.html

  1. Leventhal D et al. Treatment of keloids and hypertrophic scars: a meta-analysis and

review of the literature. Arch Facial Plast Surg. 2006 Nov-Dec;8(6):362-8.

http://www.ncbi.nlm.nih.gov/pubmed/17116782?dopt=Abstract

  1. Viera MH et al; Innovative therapies in the treatment of keloids and hypertrophic scars. J

Clin Aesthet Dermatol. 2010 May; 3 (5):20-6.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2922716/pdf/jcad_3_5_20.pdf

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