Any scar that affects the aesthetics and normal function of a person’s body needs to be treated. For example, the aforementioned linear, webbed, superfluous, bridging, depressed, atrophic, hyperplastic, contracture, instability, painful keloid scars can be treated under the guidance of a doctor who can choose the appropriate treatment to improve the local appearance and function of the scar. There are very many methods of scar treatment, which are generally divided into non-surgical treatment, surgical treatment and comprehensive treatment in medical science. Liu Guo, Burn and Plastic Surgery Center, Jining First People’s Hospital Non-surgical treatment includes: laser, freezing, pressure, physical, radiation, medicine, herbal medicine, rehabilitation and other treatment methods. Surgical treatment includes: scar excision, fractionated excision, post-excision skin slice, flap or other tissue graft, grinding, tissue expander and application of microsurgical techniques, etc. Combined treatment includes: surgery supplemented with medication, radiation or isotope therapy, medical, sports and physical therapy, medication and physical therapy, etc. Laser treatment for scarring Lasers have four main characteristics: strong monochromaticity, high directionality, high energy density and good coherence, and it is a new medical technology different from other medical light technologies. There are many types of lasers used in the medical field, but not many lasers can be used to treat scarring at present. It is mainly through the unique technology of laser itself such as burning, vaporization, cutting, coagulation and scattering illumination, by directly changing the output power of the laser or adjusting for the focused laser beam, so that it can treat different scars with different qualities. In China, laser has been used for scar treatment since 1985 with success. Laser treatment of keloid scars is applicable to: 1. flat keloid scars with no obvious dysfunction: laser dermabrasion is used to vaporize the tissue to eliminate the keloid scars; 2. scattered depressed keloid scars of different sizes and heights left after the healing of smallpox, chickenpox and acne: laser vaporization is used, which is easy, safe and painless; 3. bridge-shaped and superfluous keloid scars; 4. hyperplastic keloid scars and keloids: after routine disinfection and anesthesia, laser treatment is performed with CO2 or Nd:YAG laser will vaporize the scar tissue until the base becomes soft. Since the application of laser technology for scar treatment requires the doctor to fully understand the functions, usage and indications of various lasers, and to be proficient in the *operation* of the instruments, as well as to have strict and effective protective measures, careful understanding and selection should be made before preparing for laser treatment, and careful inquiries should be made about possible problems during and after treatment, and no hasty decisions should be made. Laser treatment for scarring, if applied properly, is generally not dangerous, but very rarely there may be local complications of scar formation and pigmentation, which are mostly due to improper mastering of the treatment depth. Oral antimicrobial agents should also be taken for 3 days after laser treatment, and the duration should be extended for patients with larger treatment areas. Do not forcibly remove the scab after the treatment, wait for it to fall off naturally, and avoid sun exposure and wind and sand stimulation after the scab removal. Radiation therapy for scar Radiation can penetrate human tissue. When it irradiates scar tissue, its radiation energy is transmitted to the tissue, causing physical and chemical damage to the scar, thus inhibiting and destroying the growth of the scar and achieving the purpose of treating the scar. Rays reaching a certain intensity, irradiated before and early after surgery, can substantially reduce the number of fibroblasts, thus reducing the synthesis of collagen fibers; at the same time, it can promote the maturation of collagen fibers and accelerate their decomposition, making the scar flat and soft. Radiation has been used as a treatment method for nearly a century. In the early days, strong penetrating X-rays were used for direct irradiation of keloid scars, but the effect was slow and the side effects were large, but now it has been improved to apply β-rays that only irradiate superficial layers after excision of keloid scars or hyperplastic scars, which shortens the treatment time and greatly reduces the side effects. It is suitable for keloid and hyperplastic keloid scars. 1. X-rays: The advantage is that the time is short and the completion of a treatment is measured in seconds(s). Thicker scars can also be irradiated in full layer. The disadvantage is that it is not easy to control deep tissues and vital organs from the effects of radiation when irradiating. 2. β-radiation: It is a new breakthrough in the treatment of scar, but the electronic beam adder is expensive and not easy to promote in China at present. Since the mid-80s, p32 and 90sr-y generated beta rays have been used to prevent and treat scarring with good results. Radiation therapy is suitable for the treatment of abnormal scarring and is usually used as an adjunctive therapy to prevent recurrence after surgery. There is almost no adverse effect on the whole body during the treatment. Individual patients have slight local reaction after irradiation, which can mostly recover after stopping the treatment. Treatment of keloid scars with intra-scar injections can be traced back to the 1950s, when it was discovered that adrenocorticotropic hormones have a variety of complex pharmacological effects, especially their inhibition of fibroblast maturation and granulation tissue growth, and were soon used by plastic surgeons to prevent and treat keloid scar growth. It eliminates symptoms such as itching and pain, in addition to subsiding and flattening the raised scar. There are many drugs for the treatment of keloid scars, currently the most commonly used in clinical practice is the direct local application of ① steroids, the route of administration is mainly local injection of scar or preparation into creams or ointments, application and patching. It is suitable for hyperplastic keloid scars and keloid scars with obvious effect. Due to the effect of the drug itself, or too large injection dose, incorrect method, different sensitivity of patients, local or systemic side effects may occur after using the drug, such as: local capillary dilation, pigmentation, loss of pigmentation, female menstrual disorders, etc. The above side effects may disappear within 1-6 months after discontinuation of the drug. Silicone preparations, the most commonly used ones are scar enemy, silicone cream, scar suppressant, etc., which are easy to use, simple, non-toxic, non-irritating, no local discomfort, but slow to show effect. It is suitable for any scar. In addition, there are other drugs such as cumecoxib, calcium channel blockers, anti-allergic drugs, anti-tumor drugs, immunosuppressants, Chinese medicine, etc., which are less commonly used in clinical practice. Although drug injections can soften and flatten the scar and make the itchy and painful symptoms disappear completely, the skin is often left with different degrees of pigmentation loss or deposition after treatment, which affects the aesthetics, especially for young women whose scar is in the exposed area, which is not easy to accept. Compression therapy for keloid scars A method of preventing scar growth and treating hyperplastic keloid scars and keloids by applying continuous pressure to the scar area with elastic fabric is called compression therapy. This method is easy to perform, has almost no side effects, and can also be used as an adjunct to drug and radiation therapy, which can reduce the dose of radiation or medication and reduce the recurrence rate. This method is suitable for patients with large hyperplastic scars or those who are not suitable for radiotherapy or local medication. Compression therapy has been used for more than 150 years to treat skin scars. The principle of action is to narrow the lumen of blood vessels in the scar through pressure, which reduces blood flow and causes a lack of nutrients in the scar tissue, thus significantly inhibiting the proliferation of scar tissue and achieving the goal of scar treatment. Cryotherapy for scarring Cryotherapy is the use of low temperature below 0℃ to freeze and destroy scar tissue for the purpose of treating scarring. This method is suitable for flat keloid scars without obvious functional impairment, scattered depressed keloid scars of different sizes and heights left after healing of smallpox, chickenpox and acne, bridge-shaped and superfluous keloid scars. This method is safe and easy to perform, but patients with deeper or oversized scars are better off not choosing this method. Surgical treatment of keloid scars 1. Excision and suturing: The most commonly used method, any scar with small area can be treated by this method. Depending on the nature of the scar, its size, the relationship between the surrounding skin and organs, and the state of the substrate, there are three types of excisional sutures: (1) direct excisional sutures, (2) staged excisional sutures, and (3) intra-scar excisional sutures. 2. Skin grafting: One of the commonly used treatments in plastic surgery is a piece of skin excluding subcutaneous fat tissue, which is used for transplantation between autologous, homogeneous or heterogeneous individuals. According to the thickness of the skin slice, it is generally divided into (1) edge-thickness skin slice, (2) medium-thickness skin slice, (3) full-thickness skin slice, and (4) skin slice with subdermal vascular network. Flap grafting: flap is a tissue block including skin and subcutaneous tissue with its own blood supply, the blood transport of flap depends completely on the tip supply in the early stage, and after the blood supply is established between the flap and the defective part, the tip can be cut off to end the flap grafting process. It is generally divided into (1) arbitrary flap, (2) axial flap, and free flap, etc. Skin Soft Tissue Dilation and Scar Treatment After more than 20 years of clinical practice, skin soft tissue dilation has become a popular treatment measure for patients and physicians, especially in the field of cosmetic surgery, where very obvious results have been achieved in the treatment of some difficult cases. For example, patients with large deep burns, the wound healed but the head, face, neck and body left a lot of hard and thick hyperplastic scar, not only ugly appearance, and inconvenience, sometimes there is pain and discomfort, the patient and family are very distressed, the past treatment methods are mainly skin implants or flap transfer to repair, these two basic methods, all need to cut skin from the patient’s own body or flap so it is bound to In addition, the good skin left on the patient with large burns is already very little, and it is not enough to replace the scars with the only good skin left, and it is very easy to grow new scars with a freehand skin cutter or skin drum, and it is not enough to take the full-thickness skin. If skin expansion is used, a small amount of skin source can be fully and reasonably used, and the “extra” skin produced after expansion can be used to replace the scar, which can be used to heal the scarred patient and restore his/her health back to work. The indications for soft tissue skin expansion are very broad and can be used on all areas of the body where “extra” skin flaps are needed to repair scarring. (1) scarring alopecia is the best indication, and can generally repair scars that occupy less than 1/2 of the scalp; (2) scars on almost all parts of the body, such as the face and neck, trunk, and extremities; (but it should be noted that after soft tissue expansion of the neck and abdomen, the flap retraction rate is large and the results are slightly worse;) (3) organ reconstruction: such as nose reconstruction, auricular reconstruction, breast reconstruction, scrotum reconstruction, etc.; (4) pre-dilation before flap transfer, skin canal (4) pre-expansion before flap transfer and skin canal formation, or after flap transfer and skin canal formation; (5) skin expansion to provide a donor area for full-thickness skin implants after distant scar excision. Evaluation: The “extra” soft tissue produced by skin soft tissue expansion is essentially an expanded flap, which has the advantage of a thinner flap, richer blood flow, and better quality of the repaired defect in terms of color, texture, sensation, and blood flow than traditional free skin grafting, ductal transfer, or free flap and distal flap repair; Moreover, part of the expanded skin and soft tissue can be used to repair the lesion and part of the donor area, avoiding the creation of new defects in the donor area, so it is popular among patients and doctors. skin necrosis, etc.).