Hand burn scar contracture deformity repair
Presentation: The scar is significantly higher than the surrounding normal skin and is locally thickened and hardened. In the early stage, the scar surface is red, flushed or purple due to capillary congestion. During this period, itching and pain are the main symptoms, and even this can lead to surface rupture due to scratching. After a considerable period of time, the congestion decreases, the surface becomes lighter in color, the scar gradually becomes softer and flatter, and the itching and pain diminish or disappear. Generally speaking, children and young adults have a longer proliferation period, while older people over 50 years old have a shorter proliferation period; the proliferation period is longer for scars with rich blood supply, such as the face, and shorter for scars with poor blood supply, such as the ends of the limbs and the anterior tibial area. Although the hyperplastic scar can be more than 2 cm thick, it is not tightly adhered to the deep tissues and can be pushed, and there are generally clear boundaries with the surrounding normal skin. The contractility of hyperplastic scars is less than that of contracted scars.
Therefore, hyperplastic scars that occur in non-functional areas generally do not cause serious dysfunction, while large hyperplastic scars in joint areas may cause dysfunction due to their thick and hard splinting effect, which hinders joint movement. Hyperplastic scars located on the flexor surface of the joint can become significantly contracted in advanced stages, resulting in significant dysfunction such as jaw and neck adhesions.
Atrophic scar Atrophic scar (atrophic scar), the injury involves the whole layer of skin and subcutaneous fatty tissue, can occur with a large area of third-degree burns.
Porphyra can dissolve the black spot scar
The clinical manifestations of keloid scars vary widely, generally manifesting as a persistent growing lump above the surrounding normal skin, beyond the original injury site, which is harder to find, poor elasticity, local oxygen or pain, early surface is pink or purplish red, late more pale, sometimes with excessive pigmentation do, and the surrounding normal skin has more obvious boundaries. The lesions vary in size from 2-3 mm papule-like to large palm-like flakes. The morphology is diverse, ranging from flat, symmetrical protrusions with regular margins to uneven, high-low masses with irregular protrusions, sometimes resembling crab feet with infiltrative growth into the surrounding tissue (also called “crab foot swelling”).
The surface is an atrophic epidermis, but the epidermis of keloids in the earlobe can be close to normal skin. Most cases are solitary, but a few cases are multiple. The keloid develops rapidly within a few weeks or months after the injury and can grow continuously and continuously or remain stable for a considerable period of time. Inflammatory necrosis may occur within the lesion due to residual follicular glands or liquefied necrosis due to central ischemia. Keloid scars generally do not undergo contracture and do not generally cause functional impairment, except for a few joint sites that cause mild restriction of movement. Keloid scars generally do not degenerate on their own; occasionally, lesions have been reported to degenerate after menopause, independent of their course, location, etiology, or symptoms. Malignant degeneration of keloids has been reported, but the incidence is very low.
Depending on the morphology of the keloid, there are several types of keloid scars that can be classified as linear keloid, webbed keloid, depressed keloid, and bridging keloid.
The etiology of keloid scars The biological mechanisms underlying the formation of proliferative keloid scars and keloids have been explored for more than a century. In the last two decades, with the continuous understanding of the biochemical mechanisms of wound healing and the improvement of research techniques, certain characteristics and patterns of keloid scar growth, especially keloid scars, have been more and more clearly elucidated, which has paved the way to finally unravel the mystery of keloid scar growth and seek the most effective treatment for keloid scar growth.
Keloid hyperplasia tends to occur in areas of high tension. It is common to see patients with keloid scars in high tension areas who have normal keloid scars in non-tension areas. In addition, keloid scars often shrink if they are excised and transplanted to a less tense area (e.g., lumbar, medial femoral, etc.).
Snssman studied the relationship between wound orientation and tension and demonstrated that the tension of an incision perpendicular to the skin relaxation line is three times higher than that of an incision parallel to the skin relaxation line, and that high tension stimulates fibrous tissue formation. Therefore, a large tension due to improper selection of surgical incisions is one of the factors that contribute to the formation of keloid scar growths.
Keloid scars can occur anywhere on the body, but are most common on the upper back, shoulders, anterior chest, upper arm deltoid area, and less commonly on the lower extremities, face, and neck.
Thick-skinned areas are more likely to occur than thin-skinned areas.
It is extremely rare in the eyelids, genitalia, palms, soles, corneas and mucous membranes.
Crockett proposed a sensitive order of keloid occurrence sites based on extensive statistical data.
First order: anterior sternum, upper back, and deltoid region of the upper arm. Almost all keloids in these areas are likely to develop into keloids.
Second order: areas with beards, ears, anterior aspect of upper extremities, chest, scalp, and forehead. The tendency to form keloids in these areas is related to the nature of the injury.
Third order: lower back, abdomen, lower extremities, midface, and genitalia. Keloid scars in these areas are uncommon.
Keloid scars have a familial predisposition.
Both recessive autosomal and dominant autosomal inheritance have been reported. The positive family history is particularly pronounced in multiple, severe keloids.
Laurentacl and Dloguardl, in a study of Oriental subjects, suggested that individuals with HLA-B14 and HLA-B16 are at greater risk of forming proliferative keloids and keloids. However, a study by Cohen et al. (1979) (on black Americans) found no significant difference in HLA typing between the antigens of HLA-A or HLA-B in keloid patients and controls, thus concluding that there is no significant relationship between any particular HLA phenotype and keloid scars.
Prevention of keloid scars
The treatment of keloid scars is very tricky and it is difficult to obtain very satisfactory results. Theoretically, once a scar has formed, even the most delicate surgical methods can only lead to partial improvement, but not complete eradication.
Because every plastic surgery is a new trauma, taking measures to maximize the prevention of scar formation is of equal importance as the treatment of scarring.
The fundamental point of scar prevention is to minimize the second trauma to the wound and to promote early phase I healing of the wound. This includes trauma management, case selection for elective surgery patients, fine surgical technique and proper postoperative management.
(I) Trauma treatment
For early fresh wounds, blood clots, foreign bodies and debris should be thoroughly removed, as well as any tissue determined to have lost viability. Close the wound as early as possible. If the wound is allowed to heal itself, scar hyperplasia, scar contracture and adhesions to deep tissues are often formed. For late contaminated wounds, if there is a possibility of infection, the wounds should be thoroughly debrided and closed is drainage is placed. If the presence of infection has been determined, antibiotics should be applied locally or systemically and the wound should be closed in phase II after the infection has been controlled.
For wounds with large tissue defects, tissue grafting should be used to cover the wounds as early as possible to reduce granulation tissue and scar tissue formation. Advancing flaps, rotating flaps, distal flaps, or free skin grafts may be used. Sometimes, the simplest surgical approach is often the wisest. Unnecessary additional incisions should be avoided whenever possible, especially in patients with a tendency to keloid scarring.
(ii) Case selection
For a patient with a malignant lesion or a predisposition to malignant change, or a patient with severe dysfunction or ulceration, there is no alternative to surgical treatment. However, for some cases, especially those requiring cosmetic or general scar treatment, plastic surgeons should carefully select the indications for surgery and determine whether the surgical treatment can improve the original scar to a greater extent before surgery. Caution should be exercised especially in children, young adults, and patients with darker skin tones, especially if the scar is not obvious or located in a hidden area or if there is no functional impairment. This is because if the procedure is not handled properly, it may make the existing scar more pronounced.
For sites where keloid hyperplasia and keloids are prevalent, such as the chest and shoulders, sites where tension and motion exist, such as the upper chest and scapulae, the flexors of the limbs, and sites where breast gravity and chest respiratory motion exist, such as the sternum, postoperative scarring is prone to hyperplasia, and surgical excision of smaller lesions in these areas, such as cysts and hemorrhoids, should be done with extra caution.
Infants and children are also prone to postoperative scar growth due to their high metabolism, and the thin skin of infants makes it difficult to accurately align the wound edges during suturing, which can affect the postoperative results.
In patients with severe oily skin, large sweat pores and acne, the possibility of postoperative scar growth should be considered. In such patients, particular attention should be paid to the local cleansing of the surgical site before surgery. If acne flares up, antibiotics should be used. When closing the wound, contamination of the wound by sebaceous glands should be avoided.
(iii) Surgical operation
1. When designing the incision, the following principles should be followed as far as possible, provided that the surgical needs are met
(1) Select hidden areas, such as under the breast, hair area, etc.
(2), Incision along the contour line.
(3), Incision along the skin line, such as in the forehead, eyelid, etc.
(4), In the natural union, such as in the ear and neck.
(5), The limb incision is chosen at the flexion crease line or parallel to the skin tension line, avoid making circular circular incisions or incisions across the joints.
(6) Temporal or lateral neck surgery can be chosen in the hairline area.
(7) Avoid making curved, semicircular or large “Z”-shaped or “S”-shaped incisions on the face.
(8) Avoid making circular incisions around the external body cavity.
(9) If the incision must cross the contour line and skin line, a “Z” reshaped incision should be designed.
2. Perform aseptic operation.
3. The blade should be cut perpendicular to the skin, with gentle movements and sharp instruments to avoid unnecessary trauma.
4. Thorough hemostasis.
5. No dead space formation.
Tension-free suture with accurate wound edge alignment; suture with wound edge alignment, not too tight to avoid causing necrosis of tissue around the suture.
Non-surgical treatment of scar
1.Chemotherapy.
2.Radiation therapy.
3.Pressure therapy.
Edit this paragraph Easy ways to remove scars When the wound has healed, what time and what should be done? In fact, this question is the most difficult to tell clearly, because the treatment of scars is a very complex issue, can only put some commonly used methods, make a simple summary, or we recommend that you try to find plastic surgeons targeted treatment is the best.
Anti-scar medication After the scabs fall off, you can use anti-scar medication, there are many kinds, but you must choose the cream produced by the regular manufacturer, not some advertising products that some patients show me only exaggerated effects. Topical creams applied to the scars can achieve the slight healing effect of moisturizing and softening, stopping itching, reducing inflammation and fading redness, and lightening pigmentation, and cannot really remove scars, and they are not effective for old scars.
Abrasion Surgery The principle of Abrasion Surgery is to smooth out the epidermis of a bumpy scar and then, through the wound healing process, regrow a new epidermis to blur the scar and improve its appearance. There are different levels of scar removal surgery, superficial scar removal has fast recovery and few side effects, but it takes several treatments to achieve results. Deep abrasion is used to improve deeper scars. A high-speed metal brush or diamond abrasion is used to smooth out the scars, but it takes a long time to recover and there may be redness and hyperpigmentation of the scars for several months, so be prepared before proceeding.
Surgical treatment Surgical treatment, after more than six months of the above treatment and after a consultation with a professional plastic surgeon, some scars require another surgical treatment.