Scars and keloids
Dr. Bassam Kh. Al AbbasiConsultant pediatric surgeon
Nineveh medical college
The maturation phase represents the formation of what is described as a scar . it mature over a period lasting a year or more.
- At first pink, hard, raised and often itchy.
- The collagen becomes denser, the scar becomes a cellular as the fibroblasts and blood vessels reduce.
scar becomes paler, softer, flattens and its itchiness diminishes( first 3 months)
-( 1–2 years) Tensile strength will continue to
increase but will never reach that of normal skin
The final appearance of a scar depend on many factors :
1-differnce between individual patients .2-the type of skin and location on the body
3-tension on the closure
4-direction of the wound(langer or relaxed skin tension line).
5-both local and systemic condition
-Crush wound healed with bad scar
- Vascular disease and nutritional disorder provide factor for bad scar
6-surgical technique
A traumatic technique and tension free suture line will provide a good line scare
Important techniqual factors affected the result
a-suture type and time of removal
example face 3-5 days
b-wound edge eversion
Types:
1-Atrophyic scar:
pale, flat and stretched in appearance, on the back and areas of tension. easily traumatised,thinned. Excision and resuturing may only rarely improve such a scar.
2-Hypertrophyic scar:
excessive scar tissue that does not extend beyond the boundary of the original incision or wound. results from a prolonged inflammatory phase and unfavourable scar siting (i.e. across the lines ofskin tension). In the face, these are known as the lines of facialexpression.
3-Keloid scar:
excessive scar tissue that extends beyond the boundaries of the original incision or wound.\- aetiology is unknown,
- associated with elevated
levels of growth factor,
deeply pigmented skin,
inherited tendency
certain areas of the body (e.g. a triangle whose Points are the xiphisternum and each shoulder tip).
-Histology of both hypertrophic and keloid scars shows
excess collagen with hypervascularity, but this is more marked in
Keloids .
-Treatment of both is difficult
-Hypertrophic scars improve spontaneously with time, whereas
keloids do not.
Treatment of hypertrophic and keloid scars
■ Pressure – local moulds or elasticated garments■ Silicone gel sheeting (mechanism unknown)
■ Intralesional steroid injection (triamcinolone)
■ Excision and steroid injection
■ Excision and postoperative radiation .
■ Intra lesional excision (keloids only)
■ Laser
■ Vitamin E or palm oil massage (unproven)