9. HYPERTROPHIC SCAR
Scar remains in the remodeling phase more
than normal scar
There is increased deposition of collagen
Scar remain red, raised, itchy for much longer
period than normal scar
Commonly occurs in situations when wound is
sutured under tension or healing has been
delayed
10. HYPERTROPHIC SCAR
Such scars are common in children and black races
Remain within the zone of original injury
They are common following burn injuries
They tend to produce contractures
They also show pigmentry changes
However unlike Keloids , hypertrophic scars tend to mature with time
11. Management of Hypertrophic Scar
Patience and counseling
Massage, Pressure, Silicon sheet or gel
will accelerate maturation
Surgical intervention if hypertrophic scar is
interfering with function
Surgery involves, scar release or Scar
Revision
12.
13.
14.
15. KELOID HISTORICAL
BACKGROUND
•First description of abnormal
scar formation recorded in the
Smith papyrus in approximately
1700 BC.
•Keloid, meaning “crab claw,”
from Greek word “chele”, first
was coined by Alibert in 1806.
16. Clinical Features of KELOID
Regarded as a different entity from hypertrophic
scar
Initiating factor is trivial injury
Occasionally arises spontaneously
It grows to extend beyond the original scar
It shows no tendency to regress. Never matures
Has a high tendency to recur after surgery alone
Usually does not produce contracture
17. Clinical Features of KELOID
Black races are more prone to this
Certain areas of the body are more prone
in susceptible individuals.
May be familial
Aetiology unknown
21. CLINICAL
HISTORY OF TRAUMA
LESIONS EXTEND PAST AREAS OF
TRAUMA
MAY BE TENDER, PAINFUL AND
PRURITIC.
USUALLY DEVOID OF HAIR
FOLLICLES.
OFTEN CONTINUES TO GROW OVER
THE YEARS.
+/- POSITIVE FAMILY HISTORY.
32. TREATMENT
NO SINGLE MODALITY IS BEST.
COMBINATION THERAPY OFTEN
BEST.
FIRST RULE OF THERAPY IS
PREVENTION.
AVOID NONESSENTIAL SURGERY IN
KNOWN KELOID FORMERS.
CLOSE ALL WOUNDS WITH MINIMAL
TENSION.
33. Treatment of keloid and
hypertrophic scar
Pressure
Intralesional steroid inj [triamcinolone]
Excision and steroid inj
Excision and postop radiation
Silicone gel sheeting
Laser
34. Steroid injection side effects
Sub cut. Tissue atrophy
Telangiectasia
Pigmentary changes
36. STEROID THERAPY
REDUCE COLLAGEN SYNTHESIS.
REDUCES FIBROBLAST PROLIFERATION.
TRIAMCINOLONE ACETONIDE MOST
COMMONLY USED.
RESPONSE RATES VARIED BETWEEN 50 –
100%.
WHEN COMBINED WITH EXCISION,
RECURRENCE RATE OF 0 – 100%
REPORTED.
WATCH OUT FOR COMPLICATIONS.
37. OCCLUSIVE DRESSINGS
USE OF SILICONE GEL SHEETS AND
OCCLUSIVE DRESSINGS.
VARIED SUCCESS.
EFFECT A RESULT OF OCCLUSION
AND HYDRATION.
DRESSING WORN 24HRS/DAY FOR UP
TO 12 MONTHS.
EXCELLENT RESPONSE IN UP TO
35%OF CASES.
38. PRESSURE
KNOWN TO HAVE THINNING
EFFECTS.
PRESSURE APPLIED 12 – 24
HRS/DAY
REDUCES COHESIVENESS OF
COLLAGEN FIBRES.
OVERALL, 60% OF PATIENTS
SHOWED 75 – 100%
IMPROVEMENT.
39. CRYOSURGERY
CAUSE CELL DAMAGE VIA
INTRACELLULAR CRYSTALS
LEADING TO TISSUE ANOXIA.
DUAL BENEFIT TOP THE PATIENT;
ANAESTHETIC EFFECT AND EASE
OF INJECTIONS
AS A SINGLE MODALITY,
REPORTED TOTAL RESOLUTON IN
51 – 74 % CASES.
40. RADIATION THERAPY
USE REMAINS
CONTROVERSIAL. SAFETY
HAS BEEN QUESTIONED.
OFTEN FOLLOWS EXCISION.
RECURRENCE RATES OF 21 –
53 % REPORTED.
41. LASER THERAPY
CAUSES MINIMAL TISSUE
TRAUMA.
PHOTOTHERMOLYSIS LEADS
TO MICROVASCULAR
THROMBOSIS.
WHEN USED AS A SINGLE
MODALITY SHOWED 39 – 92 %
RECURRENCE RATES.
42. INTERFERON THERAPY
REDUCE KELOIDAL
FIBROBLAST PRODUCTION OF
COLLAGEN I, III, VI
MESSENGER RNA.
FEWER RECURRENCES
REPORTED – 18%.
43. Keloid and hypertrophic scar
Cinical features Hypertrophic scar keloid
Always preceded by
injury
yes no
Anatomical association no yes
Extent of growth limited to wound Extends beyond the
wound
Resolves Spontaneously Yes No
Recurs after surgery No Yes
Associated with
contracture
Yes No
Over all
incidence[blacks]
Common Common
Associated with race No Yes
44. CONCLUSION
Keloid is still a major problem for
pigmented races
Differs from hypertrophic scar in its natural
history
Extends beyond the margin of original
injury
Does not usually improve with time
Tend to recur readily with surgery alone
Combination therapy advocated.