Efficacy and Safety of Punch Excision Combined With Adjuvant Therapies for Hypertrophic Scars and Keloids: A Narrative Review

TL;DR

This review evaluates the effectiveness and safety of punch excision combined with other treatments for treating hypertrophic scars and keloids, highlighting its benefits and areas needing further research.

Contribution

The paper provides a systematic review of punch excision techniques for pathological scars, emphasizing clinical outcomes and future research needs.

Findings

Punch excision effectively restores aesthetics and function in patients with pathological scars.

There is significant variability in patient response and long recovery times with the technique.

Current evidence lacks stratification across scar types and disease stages, requiring more research.

Abstract

Pathological scars manifest as firm, elevated, erythematous plaques, or nodules after skin injury. As challenging wound‐healing complications, hypertrophic scars and keloids significantly compromise aesthetics while causing functional impairment and psychosocial distress. Consequently, their management remains a central focus in dermatology. The skin punch has undergone substantial technical advancements, emerging as a promising therapeutic modality.

To evaluate the efficacy of punch‐based techniques in managing pathological scars, we conducted a comprehensive literature search using Boolean logic across electronic databases, with the core search strategy built upon the following terms: (“skin punch” OR “punch excision” OR “punch volume reduction”) AND (“pathological scar” OR “hypertrophic scar” OR “keloid”). Additional relevant studies were identified through citation tracking of the retrieved articles. This review systematically examines recent advancements in punch‐assisted scar management, with particular focus on the mechanistic basis, diverse therapeutic modalities, clinical efficacy, and associated complications.

This systematic appraisal of punch volume reduction for pathological scars affirms its robust efficacy in restoring aesthetic contour and functional integrity, while concurrently revealing substantial interpatient heterogeneity in therapeutic response and protracted convalescence intervals. Although the technique's clinical value is well‐established, a critical deficit persists in stratified evidence across scar phenotypic spectra and temporal disease dynamics, with no codified protocols to direct therapeutic application. Confronted by the profound quality‐of‐life impairment attributable to pathological scars and accelerating clinical necessities, forthcoming research mandates large‐scale prospective cohorts with prolonged surveillance, emphasizing technical innovation, preemptive complication management, and individualized treatment algorithms. The consolidated insights presented herein deliver both actionable guidance for contemporary evidence‐based practice and a foundational conceptual architecture for future technological evolution in scar therapeutics.

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