Transcript
SCARS
Dr Alamzeb KhanPlastic Surgeon Northwest General Hospital & Research CentrePeshawar , PAKISTAN
Substitution of a
different cellular matrix
as a patch to re establish both physical and physiologic
continuity to the injured organ is called
scar formation
CLASSIFICATION OF SCARS
•Mature scar•Immature scar•Linear hypertrophic•Widespread hypertrophic•Minor keloid•Major keloid•Mustoe TA, Cooter RD, Gold MH, et al. International clinical recommendations on scar management. Plast Reconstr Surg. 2002;110:560–571.
A light-colored, flat scar
A red, sometimes itchy or painful, and slightly elevated scar (remodeling). Many of these will mature normally over time
This usually occurs within weeks of surgery. These scars may increase in size rapidly for 3–6 months and then, after a static phase, begin to regress.
A widespread red, raised, sometimes itchy scar confined to the border of the burn injury
A focally raised, itchy scar extending over normal tissue. This may develop up to 1 year after injury and does not regress on its own.
A large (more than 10 cm2), raised (>0.5 cm) scar, possibly painful or pruritic and extending over normal tissue.
Keloids and Hypertrophic scars
The prolonged inflammationdelays the healing response and drives the formation of keloids and HSs
Exact cause is unknown
But
Huang C, Akaishi S, Hyakusoku H, et al. Are keloid and hypertrophic scar different forms of the same disorder? A fibroproliferative skin disorder hypothesis based on keloid findings. Int Wound J. 2012 Nov 22. [Epub ahead of print].
•Avoid injury or incision in keloid-prone persons•Avoid incision in keloid-prone areas• Incision along relax skin tension lines•Meticulous surgical techniques•Good wound care : rapid healing
Surgical
•Excision +postsurgical radiotherapy•Tension-reduction or shielding methods (z-plasty, w-plasty)•local flaps to cover the wound•Serial excision•Tissue expansion
Excision and post operative radiation
W-Plasty and Z-Plasty
W-Plasty
Z -PlastyZ-plasty
Release and skin grafting
Serial excision
Non surgical•silicon sheeting and gel•Pressure garments• injections (steroids, verapamil)•Topical application of steroids .•Snake oil
Silicone gel sheeting has demonstrated the ability to dramatically hasten hypertrophic scar maturation and decrease associated symptoms of pain, rigidity, and pruritus. Majan JI. Evaluation of a self-adherent soft silicone dressing for the treatment of hypertrophicpostoperative scars. J Wound Care. 2006;15:193–196.
Argument exists over silicone’s mechanism of action. One line of
evidence points to increased hydration from occlusion leading to a
decrease in inflammatory cytokines. Alternative
suggested mechanisms include a direct effect by silicone particles and an increase in static electrical fields.
Ahn, S. T., Monafo, W. W., and Mustoe, T. A. Topical silicone gel: A new treatment for hypertrophic scars and contractures. Surgery 106: 181, 1989.
In 2005 Van den Kerckhove et al found improved scar thickness when garment
pressure was above 15 mmHg.
Perhaps most discouraging was a 2009 meta-analysis of six RCTs, including thoseabove, which found only marginal improvements ofquestionable clinical significance in scar thickness.
Steroid has been shown to decrease collagen gene expression.Mixed with 2% plain Lidocaine in a 50 : 50 ratio, Triamcinolone 10 mg/mL is commonly used initially; if no response occurs, 40 mg/mL concentration is attempted. Injection are repeated monthly.
In multiple retrospectiveseries, complete flattening or greater than 80% volume reduction occurred in 73–85% of lesions treated with liquid nitrogenRusciani L, Rossi G, Bono R. Use of cryotherapy in the treatment of keloids. J Dermatol Surg Oncol. 1993;19: 529–534.
The application of snake oil in traditional African medicine, is a nutrition-based therapy that seems to have some efficacy. Louw L. Keloids in rural black South Africans. Part 3: a lipid model for the prevention and treatment of keloidformations. Prostaglandins Leukot Essent Fatty Acids 2000;63:255–262.
Acne scars
Acne affects up to 80% of the adolescent population.
The incidence of acne scarring is
about 95%.Goulden V, Stables GI, Cunliffe WJ. Prevalence of facial acne in adults. J Am Acad
Dermatol. 1999:41:577–580 1
History
•Most bothersome aspect of scarring
•How distressed is the patient
•Patient’s goals for treatment?
•Any prior procedure
•Any active acne?
•History of Post inflammatory hyperpigmentation
•History of keloids and hypertrophic scars?
Physical examination
•Good light •Give the patient a mirror to point out lesions•Active acne•Type of scar•Assess colour•Depth of the lesions•Stretch the skin and see if scars disappear•Palpate for fibrosis•Skin type
Treatment options for Post acne scars
•Resurfacing procedures•Lifting procedures•Excisional techniques•Other
Resurfacing with dermabrasion
Resurfacing with LASER
Thank you for listening
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