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. 2005 Dec 31;18(4):202-10.

Management of keloid and hypertrophic scars

A S Edriss  1 , J Mesták
Affiliations

Management of keloid and hypertrophic scars

A S Edriss et al. Ann Burns Fire Disasters. .

Abstract
in English, French

Scar management for the prevention of excessive scar formation has always been important but never so important as it is today. Optimal management continues to be an enigma for surgeons, and the best modality of treatment has been debated for many years. However, most studies have unfortunately been either retrospective or case report descriptions. Advances in scar management have been hampered by confusing or ambiguous terminology. There is no consensus on what amount of post-traumatic skin scar formation is "normal" and what should be considered "hypertrophic". In the World Health Organization's ICD-9, there is no diagnostic code for hypertrophic scar - only keloid is listed. Yet the medical and scientific literature distinguishes them as different conditions. This confusion results in inappropriate management of scar formation, and occasionally contributes to decision making related to elective or cosmetic surgery. Our experience suggests that there is no single treatment for scars that is adequate and that clinical judgement is very important when considering treatment and balancing the potential benefits of the various treatments available. The goal of treating scars is to restore functionality, provide relief of symptoms, enhance cosmetics, and prevent recurrence. This article is based on our scientific and clinical experiences and focuses on over-the-counter options to manage keloid and hypertrophic scars.

La gestion des cicatrices pour prévenir leur formation excessive a toujours été importante, mais jamais comme aujourd'hui. La gestion optimale reste une énigme pour les chirurgiens, et on discute depuis nombreuses années sur la meilleure modalité de traitement. Cependant, la plupart des études ont été malheureusement ou rétrospectives ou des descriptions de cas particuliers. Le progrès dans le champ de la gestion des cicatrices a été ralenti par une terminologie confuse ou ambiguë. On n'est pas d'accord sur la quantité de la formation de cicatrices cutanées post-traumatiques que l'on peut considérer comme "normale" et ce que l'on peut considérer comme "hypertrophique". Le ICD-9 de l'Organisation Mondiale e la Santé ne contient aucun code diagnostique pour la cicatrice hypertrophique - il cite seulement la cicatrice chéloïdienne. Mais la littérature médicale et scientifique les distingue comme des conditions différentes. Cette confusion porte à une gestion inappropriée de la formation des cicatrices, et en certains cas contribue au processus pour la prise de décisions pour ce qui concerne la chirurgie élective ou cosmétique. Selon l'expérience des Auteurs, il n'existe pas un seul traitement efficace, et le jugement clinique est très important quand on considère le traitement clinique et pèse les bénéfices potentiels des divers traitements disponibles. Le but du traitement des cicatrices est de restaurer la fonctionnalité, soulager les symptômes, améliorer l'aspect cosmétique et prévenir les récidives. Les Auteurs présentent leurs expériences scientifiques et cliniques et décrivent les options commerciales pour la gestion des cicatrices chéloïdiennes et hypertrophiques.

Keywords: HYPERTROPHIC; KELOID; MANAGEMENT; SCARS.

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Figures

Fig. 1
Fig. 1. Before first operation. Pre-operative view from anteroposterior (left) side.
Fig. 2
Fig. 2. Before first operation. Pre-operative view from lateral (right) side.
Fig. 3
Fig. 3. Intra-operative view. Full-thickness skin graft
Fig. 4
Fig. 4. Upside down view of excised keloid.
Fig. 5
Fig. 5. After removal of suture (2 weeks post-op). Note the extent of inflammation.
Fig. 6
Fig. 6. Keloid recurrence one year post-op.
Fig. 7
Fig. 7. After removal of suture, 2 weeks post-op and immediate treatment as described previously.
Fig. 8
Fig. 8. Four weeks post-op. Surgical partial excision (according to our chart).
Fig. 9
Fig. 9. Seven weeks post-surgical excision and other treatments as described.
Fig. 10
Fig. 10. Showing use of silicon gel and pressure therapy.
Chart
Chart. Keloid and hypertrophic scar management (by A. Edriss, based on scientific and clinical experience, but requiring a greater number of patients, long-time follow-up, and photographic documentation)
See this image and copyright information in PMC

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