Scarring is a normal process of tissue injury repair and an important product of wound healing, without scarring there is no wound healing. However, excessive keloid hyperplasia, keloid contracture, keloid carcinoma and keloid formation cause great pain to patients and impose a huge burden on medical work. The key to surgical treatment of keloid scars is to remove the scar while preventing the creation of new ones. Surgical treatment of keloid scars requires different methods according to the characteristics of different scars. Common types of clinical scarring superficial scarring depressed scarring linear, bridge-like, superfluous scarring atrophic scarring hyperplastic scarring contractural scarring keloid scarring keloid scar cancer 1, superficial scarring Characteristics: superficial, abnormal color, affecting aesthetics, but most of them do not have functional disorders. Treatment principle: no impact on aesthetics, generally do not give surgical treatment; occurs in the face or exposed parts of the psychological burden caused by aesthetic obstruction, can choose surgical treatment, but should be treated with caution! Surgical methods: ① scar area is small, a one-time surgical excision direct suture; larger areas of excision suture. ② skin abrasion, in the flat part of the forearm, can use the roller type skin cutter removal. ③ skin soft tissue expansion can also be selected. Generally do not choose the method of keloidectomy, free skin grafting. Second, depressed keloid scars Characteristics: divided into superficial depression and deep depressed keloid scars. The former is mostly asymptomatic and dysfunctional, while the latter seriously affects aesthetics and is often accompanied by dysfunction. Treatment principle: the former is the same as superficial scar, but the latter, in addition to excision of scar tissue to loosen adhesions, should also be used according to the degree of depression to fill the defect. Treatment: Superficial depressed scar: grinding, excision suture, CO2 laser, collagen injection, fat granule injection, skin soft tissue expansion, etc. Deep depressed scar: complete excision of scar tissue as appropriate, transplantation of autologous tissue, allogeneic decellularized dermal matrix, etc. in the depression; or fill in tissue substitutes such as silicone rubber, artificial bone, expanded polytetrafluoroethylene and so on. Attention should be paid to the problem of tissue tension after skin coverage after scar excision, in order to ensure the success of the operation, often using local flap transfer to cover the trauma. Third, linear, bridge-shaped and redundant keloid scar Characteristics: all named after the shape of the scar Linear scar: often found in trauma or surgical incision scar, part of the “centipede-like” appearance, generally does not cause functional disorders. Bridging and redundant scar: as its name suggests, it is simpler when it occurs in limited scarring, and more complicated when it occurs in extensive scarring, which affects the appearance and function. Treatment principle: linear scar: excise the scar, change the direction and tension of the incision if necessary. Bridging and redundant scar: comprehensive consideration, excision of the scar, repair of the appearance. Treatment: linear scar: direct excision and suture, or “W”-plasty or Z-plasty, surgical operation should pay attention to the subcutaneous free dilatation and prevent the flap angle is too small due to the tip of the flap blood flow obstacles. Bridge-like, superfluous scar: a small number of simple skin bridge, skin superfluous can be directly excision suture. For most of the larger complex skin bridges and redundant skin, the rolled skin should be cut and flattened to form a double-tip or single-tip flap, which can be used to repair the trauma after excision of the scar. Atrophic scar is characterized by the most unstable scar tissue, also known as unstable scar. The scar tissue is very thin, flat surface, hypopigmented, hard texture, poor local blood circulation, superficial only covered with a layer of atrophic epithelial cells, susceptible to external forces and rupture ulcers, long lasting, and can be malignant in the late stage. The scar is tightly adhered to the deep tissues; it has great contractility and often pulls the surrounding normal tissues, causing serious dysfunction. The principle of treatment is to decide whether to directly excise and suture the scar according to the size of the scar, or to use skin grafting or flap graft repair. Proliferative scarring Characteristics: common, divided into proliferative, decompensated and mature stage, with the possibility of self-degeneration and softening. Treatment principle: Early stage (proliferation and regression) should be preceded by non-surgical treatment to inhibit and reduce the proliferation of keloid scars, and in special cases, surgery should be given to correct the deformity, repair the appearance, and prevent the complication of deformity. Most of them will be treated surgically after the scar matures and softens. The principle of surgery is to excise the scar, loosen it sufficiently, correct the deformity, and repair the wound with a skin sheet or flap. For cases with extensive scar and lack of skin source, only incision or partial excision of the scar can be made, and only contracture relaxation is sought, and the wound can be repaired with skin flap. For special parts of hyperplastic scar, the effect of simple excision and skin grafting is often unsatisfactory, and the effect of using skin flap transfer repair is better. Treatment: non-surgical treatments, such as elastic compression therapy, intra-scar drug injection, functional exercise. Surgical methods: according to the site, area and size of the scar and the appropriate choice of surgical treatment: direct excision and suture, keloid excision and skin grafting or skin flap transfer, skin and soft tissue expansion, keloid skin replantation, and so on. Contracture scar Characteristics: It often occurs in the area of trans-articular joints and around the open organs, causing organ displacement and deformation, functional limitation, and greater harm. Treatment principle: cut or excise the scar, completely loosen the contracture, change the direction and position of the tension line, and repair the function and appearance. For large contracture scar, excision of medium-thickness or full-thickness skin graft, if necessary, can be repaired with skin flap. Complete release of contracture is the key step in surgical treatment. Generally speaking, if the contracture is mild, the scar is not deep, and it is not a joint area, medium-thickness skin graft is more suitable. For deep scar contracture, since the location, scope and depth of the scar are often difficult to determine before surgery, it is necessary to make a thorough study before surgery, carefully design the surgical plan, and then investigate clearly during the surgery, and try to use tissues to fill up the cavity created after scar excision. Treatment: Z-plasty, multi-Z-plasty, five-flap plasty, W-plasty, V-Y or Y-V flap can be used. For severe contracture scar, the flap can not cover all the trauma after displacement, free skin graft or local flap transfer can be used to repair. For webbed scar such as anterior neck, skin soft tissue expansion is a good choice. Generally, it is loosened from the incision perpendicular to the longitudinal axis of the contracture, and peeled gradually along the layering of scar and normal tissue until the contracture is completely released. Sometimes adjunctive procedures such as tendon lengthening, capsulotomy, and resection of joint ligaments are also required to achieve adequate release. If the contracture cannot be reset at one time, postoperative traction, arthroplasty or fusion can be performed according to the situation. Keloid scar Characteristics: Tumor-like growth, cannot subside on its own, and very easy to recur after simple surgical excision. Treatment principle: keloid surgical treatment must be careful, should avoid simple surgery, but should take surgery-based comprehensive treatment. Small area can also be used to long-acting adrenocorticotropic hormone-based intrakeloid drug injection therapy. Treatment methods: preoperative radiation therapy – surgical excision – glucocorticoid injection at the edge of the incision – compression therapy, hormone injection – cryo – hormone injection therapy, surgical excision – radiotherapy, intralesional excision and so on. Surgical excision suture should minimize the tension on the suture margin, and if necessary, the method of skin grafting is used. Keloid drug injection therapy Keloid drug injection therapy Keloid hand excision suture plus radiation therapy Keloid surgical skin graft + radiation therapy Keloid surgical partial excision + drug injection therapy Keloid surgical excision plus drug injection therapy Keloid surgical + radiation therapy VIII.Keloid carcinoma Keloid tissue can undergo malignant transformation to become keloid carcinoma. Clinical features: it mostly occurs in unstable scar, especially when the scar is ulcerated and does not heal for a long time; it usually has a long history of chronic ulceration and itchy symptoms before the cancerous transformation, and the course of the disease is slow; most of the cancers do not spread and metastasize after the cancerous transformation. Treatment principle: It is currently advocated that chronic non-healing ulcers should be repeatedly excised from multiple sites for pathological examination and early diagnosis of cancer; once diagnosed, early surgical excision of the lesion should be carried out, and radiotherapy or chemotherapy should be used when necessary. Choosing a good doctor is the biggest wish of every beauty seeker, and I hope I am the best choice for you. Because of my specialty, I am the best. Patients who need surgery need to make an appointment in advance, my phone number is in the profile. This coursework is written by my mentor, Prof. Jinglong Cai, and I would like to thank my postgraduate mentor for enlightening me on plastic surgery.