1, scar and keloid Scar is the inevitable product and final result of human trauma repair process, and is an important part of human self-defense system. The healing of any trauma is accompanied by scar formation of different degrees. However, if the growth of scar exceeds a certain limit, various adverse consequences will occur. For example, excessive repair of traumatic surface may cause proliferative scar; some scar contracture, causing the destruction of body surface integrity or various degrees of dysfunction; unstable scar that heals and collapses at times may cause cancer.
2.Classification of keloid scars Clinically, keloid scars are divided into the following types, each with different clinical manifestations and consequences, and different treatment methods.
(1) Superficial scar: Mostly seen after skin abrasions, superficial infections or superficial burns. These scars are rough in appearance and sometimes have pigmentation changes, but they are locally flat and soft, without functional impairment, and gradually become less obvious after time.
(2) Linear (cord-like) scar: It is common after the healing of trauma or surgical incision, and can form proliferative scar scar in serious cases. This kind of scar not only causes shape defects, but also sometimes causes functional disorders due to linear scar contracture.
(3) Webbed scar: The scar is wrinkled and resembles a duck web, so it is called webbed scar. These scars are usually found on the flexors of the joints, and also on the openings of tubular organs on the body surface, such as the corners of the mouth, nostrils, urethra, vaginal opening, etc. In the joint area, the scar will contract and cause joint flexion deformity, and gradually form a wrinkled wall and become a webbed scar.
(4) Depressed scar: The scar surface is significantly lower than the surrounding normal skin, showing depressed deformity, called depressed scar. o Depressed scar can be caused by the healing of skin, subcutaneous tissue or deep tissue trauma, or can be caused by severe septic infection of the soft tissue of the skin. If the defect is limited to the skin and subcutaneous tissues, the depression deformity is shallow and mostly has only cosmetic effects without functional impairment. Defects involving deep tissues such as muscles or bones are often associated with functional impairment and require surgical repair.
(5) Atrophic scar: The appearance is mostly flat, flush with the surrounding skin surface or slightly lower. The surface is smooth and shiny, with some hypopigmentation showing pallor, some pigmentation showing dark brown, and some pallor and dark brown presented in the same area. The texture is tough and soft, the base is loose and can be lifted and pinched. These scars are mostly found on the face and chest and back, and are generally more stable, do not cause dysfunction and do not require surgery.
(6) Bridge-shaped scar: The two ends of the scar are connected to the normal skin by the tip, and the lower channel is separated from the base, shaped like a bridge, called bridge-shaped scar. It is mostly seen in the eyelid, lower collar, anterior neck and axilla. The scar is generally short and rarely associated with dysfunction, but the local unevenness is an obstacle to the appearance, and it is difficult to clean the area and often causes infection, so surgery is often required. It is only later that degenerative changes occur gradually.
(7) Keloid scars: These are keloids characterized by persistent hyperplasia. It often appears as a crabfoot-like infiltration into the surrounding healthy skin. The lesions are elevated above the normal skin, exhibit high and low elevations, are extremely irregular in shape, are tough and itchy. It is very easy to recur after surgical excision.
3. Treatment: Non-surgical and surgical treatment (1) Non-surgical treatment Compression therapy: It is suitable for those who have large scar area and are not suitable for radiotherapy or local drug injection treatment, and is not effective for active keloid. The success of compression therapy is based on three elements: first, “early”, that is, to start compression as soon as possible after wound healing; second, “tight”: 16~18mmHg is appropriate; third, “persistent”, that is, to ensure the continuity of compression. ensure the continuity of pressure. Generally, after 3~6 months of continuous compression, the scar congestion will disappear and the bulge will flatten; after 8~10 months, most of the patients can terminate the compression.
Topical drug therapy: local direct application of steroids. Topical medication can thin the local dermis and stop the growth of granulation tissue on wounds that tend to heal.
Radiation therapy: Application of superficial radiation therapy is more effective for early lesions, but not suitable for the young or for large scarred areas.
(2) Surgery: Proliferative scar is best operated after 6 months or more or less years when the scar is softened and stabilized, but if it affects function or development it cannot wait.