Indications and timing of surgery: Surgery alone is not recommended for keloid scars; active hypertrophic scars are contraindicated for surgery; recurrence rate after surgery for mature hypertrophic scars is relatively low, and surgery can be performed selectively; patients with keloid body are not suitable for surgery because they are prone to recurrence after surgery.
The hypertrophic scar usually matures after 0.5 to 2 years, the scar becomes soft and flat, and the congestion subsides, therefore, it is better to perform surgery after 6 months or 1 year. However, in areas where function is affected, the scar should be promptly excised, the tissue loosened, and skin grafts performed. For keloid scars, intra-scar medication is recommended until the lesion is no longer receding, then surgery is performed.
For small keloids and hypertrophic scars, all of them can be excised at once and fixed with reliable dermal sutures and adhesive tape for 1 month to reduce suture tension; for larger scars, partial excision can be used to reduce tension at the suture site after surgical excision; selective excision of keloids leaves only a flap on the surface without increasing local tension, which is called excision method. However, the clinical use of this method is limited by the tendency to cause hematoma and necrosis under the flap and the difficulty of surgical operation; for those with obvious symptoms, high cosmetic requirements, and large areas that cannot be directly sutured, skin grafting can be considered and postoperative radiotherapy or intradermal injection can be applied to prevent recurrence.
Surgical precautions and clinical experience: (Presume the tendency of keloid according to the history of previous trauma;) (The recurrence rate after surgery is generally low for hypertrophic keloid scars that have been infiltrated and reddened in the past and are now flattened and reddened;) (It is better to use radiotherapy and other comprehensive treatment after surgery, and if radiotherapy is used after surgery, surgical treatment can be considered for those who are considered contraindicated for surgery;) (During surgery (The operation must be performed in strict accordance with the principles of asepsis and non-invasiveness, with incisions made along the skin line, gentle movements, sharp instruments, to prevent unnecessary trauma, adequate hemostasis, and no dead cavity left behind;) Suture the skin under no tension, or use skin grafting or “Z” shaping if the tension is high, align the suture with the wound edge, do not overtighten, and remove the suture in time, To reduce the recurrence of postoperative scarring.