• Archives of Plastic Surgery
• /
• 제49권4호
• /
• pp.554-560
• /
• 2022

Background Hypertrophic scars cause aesthetic concerns and negatively affect the quality of life. A gold standard treatment for hypertrophic scars has not been established due to various responses of modalities. Extracorporeal shock wave therapy (ESWT) is a noninvasive and affects scar remodeling by fibroblast regulation. This study investigated the effectiveness of ESWT for hypertrophic scars. Methods Twenty-nine patients were enrolled. All patients underwent ESWT once a week for 6 consecutive weeks. Their scars were assessed using the Patient and Observer Scar Assessment Scale (POSAS), erythema index, melanin index, and scar pliability before treatment and again 4 weeks after treatment completion. Results Thirty-four hypertrophic scars in this study had persisted for between 6 months and 30 years. Most scars developed after surgical incision (55.88%). The chest and upper extremities were the predominant areas of occurrence (35.29% each). Most of the POSAS subscales and total scores were significantly improved 4 weeks after treatment (p < 0.05). Furthermore, the pain, itching, and pigmentation subscale were improved. The pliability, melanin index, and erythema index were also improved, but without significance. The patients were satisfied with the results and symptoms alleviation, although subjective score changes were insignificant. No serious adverse events were found. The patients reported pruritus in 62.5% and good pain tolerance in 37.5%. Subgroup analyses found no differences in scar etiologies or properties at different parts of the body. Conclusion The ESWT is a modality for hypertrophic scar treatment with promising results. Most of POSAS subscales were significantly improved.

• Applied Microscopy
• /
• 제3권1호
• /
• pp.29-38
• /
• 1973

Introduction. The human cutaneous scars manifest themselves many ways in different types according to the factors such as the age, sex, race of the patient as well as the location,. kind and heal ing process of the wound. Among the scars it is quiet difficult to verify the clinical course of the hypertrophic or keloidal scars from the true keloids. However, clinical observations indicate that stress, either mechanical or in the forms of chronic infections, can induce a functional change in the fibroblasts causing an excessive production of collagenous matrix. In this study, we preliminary attempt to justify any difference of the cellular structure between keloids and hypertrophic scars by using electron microscope. Material and Methods. A total of 23 cases: 2 scars, 2 hypertrophic scars and 19 keloids are examined. Immediately, the biopsy tissue was fixed in 10% neutral formalin and 4% glutaraldehyde solution in phosphate buffer for 4 hours, post fixed in 1 % osmium tetraoxide for two hours, dehydrated with graded alcohol, and embedded in Epon 812. Thick sections were stained with hematoxylin eosin, periodic acid-Schiff(PAS) and Van Gieson stain. Thin sections were cut and uranyle acetate, lead citratestain and examined with the electron microscope. Result. The morphologic features of keloid showed thick, homogenously eosinophilic bands of collagen and numberous large active fibroblasts. The hypertrophic scar and soft scar are more cellular than keloid and composed thinner collagenous fiber. For this paper in the etiology of keloids can not as be defined, but and interesting keloidal tissue fibroblast showed irregular nucleus with irregular shape dense bodies and fibril materials contained in to the cytoplasm.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제34권6호
• /
• pp.494-497
• /
• 2012

Traumatic lacerations are common in the orofacial region as a result of accidents. Due to the frequent movement of the skin around the mandible, scars in that area are more likely to widen or become hypertrophic. Treatment of facial laceration was performed on three patients and followed by regular check-up. It was discovered that the scars have become hypertrophic, so steroid injections were used. The results were satisfactory with the decrease in sizes and hardnes of the scar. Facial scarring is a particularly distressing phenomenon and has always been a challenge to treat as the scars are more likely to widen or become hyphertrophied due to the frequent movement of the muscle in the facial area. We confirmed that the positive effect of steroid on hypertrophic scars. So, we suggest that proper treatment and periodic follow-up, adjuvant treatments especially steroid injection is necessary in patients with lacerations.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제33권3호
• /
• pp.210-217
• /
• 2011

Purpose: This study was to evaluate the synergistic effects of combined therapy of steroid and anti-neoplastic drug injection on hypertrophic scars in a rabbit model. Methods: Adult male white rabbits weighing about 2.5 kg were used. After full thickness wounding (about 6 mm) over the ventral surface of each ear sized was made, either saline (control group), triamcinolone, 5-fluoruracil, and mixture of triamcinolone and 5-fluoruracil were injected once 16 days after the wound was made. Rabbits were sacrificed 2, 4 and 8 weeks after injection, and tissue specimens were prepared for histologic and histomorphometric examinations. Results: With the combined injection of triamcinolone and 5-fluoruracil, collagen fiber thickness was arranged in a somewhat irregular manner 2 weeks after injection. After 4 weeks, blood vessels and inflammatory cells were decreased, and collagen fibers were arranged in an almost parallel manner. By 8 weeks, almost same amount of connective tissue compared with adjacent normal tissue was observed. Conclusion: These results indicated that combined injection of triamcinolone and 5-fluoruracil reduced the amount of hypertrophic scars by inhibition of fibroblasts and inflammatory cells. Therefore, combined injection of triamcinolone and 5-fluoruracil is a more potent and effective treatment of hypertrophic scars compared with the single injection of either triamcinolone or 5-fluorouracil.

• Archives of Plastic Surgery
• /
• 제33권6호
• /
• pp.700-705
• /
• 2006

Purpose: For hypertrophic scars and keloids no universally effective treatment modality exists. Surgical revision, intralesional steroid injection, silicone gel sheeting, pressure, laser, and others have been used with variable success, but many treatments are associated with high recurrence rates. Although optimal treatment remains undefined, successful treatment can be obtained through a combined therapeutic approach. Methods: We used three therapeutic modalities in combination, which are intralesional injection of triamcinolone acetonide, silicone gel sheeting, and 585 nm flashlamp-pumped pulsed dye laser. Fifty-eight cases of hypertrophic or keloid scar were treated by combined therapeutic regimen for mean period of 18 months. The changes of thickness, color, and pliability of scars were evaluated with clinical photographs by grading scale. Results: As summing the grades and categorizing the result into three group, we obtained 28% good, 67% fair, and 5% poor results. There was a desirable improvement of scars with insignificant adverse effects. Conclusion: Combination of intralesional steroid injection, silicone gel sheeting, and pulsed dye laser can lead to successful treatment of hypertrophic scar and keloid.

• Archives of Plastic Surgery
• /
• 제48권2호
• /
• pp.149-157
• /
• 2021

Scars vary from mature linear scars to abnormal excessive scars such as hypertrophic scars and keloid scars. Keloid scars are fibro-proliferative disease entities that reflect an abnormal process of wound healing. They can cause pain, itching, stiffness, and psychological distress, all of which can affect quality of life. Various treatment options have been advocated as ways to prevent and treat keloid scars. These include noninvasive treatments such as use of silicone gel sheeting and compression therapy, and invasive treatments such as intralesional corticosteroid injections, surgery, and radiotherapy. Novel treatments include chemotherapy, immunotherapy, and anti-inflammatory therapies. Unfortunately, keloids continue to pose a significant challenge due to the lack of efficacious treatments. Therefore, clinicians should be familiar with various therapeutic options and apply the most suitable treatment plan for patients. In this review, we introduce the current therapeutic options for the management of keloid scars.

• Archives of Plastic Surgery
• /
• 제42권1호
• /
• pp.20-27
• /
• 2015

Background Hypertrophic scars and keloids are associated with abnormal levels of growth factors. Silicone gel sheets are effective in treating and preventing hypertrophic scars and keloids. There has been no report on the change in growth factors in the scar tissue following the use of silicone gel sheeting for scar prevention. A prospective controlled trial was performed to evaluate whether growth factors are altered by the application of a silicone gel sheet on a fresh surgical scar. Methods Four of seven enrolled patients completed the study. Transforming growth factor (TGF)-${\beta}1$, platelet-derived growth factor (PDGF), and basic fibroblast growth factor (bFGF) were investigated immunohistochemically in biopsies taken from five scars at 4 months following surgery. Results In both the epidermis and the dermis, the expression of TGF-${\beta}1$ (P=0.042 and P=0.042) and PDGF (P=0.043 and P=0.042) was significantly lower in the case of silicone gel sheet-treated scars than in the case of untreated scars. The expression of bFGF in the dermis was significantly higher in the case of silicone gel sheet-treated scars than in the case of untreated scars (P=0.042), but in the epidermis, the expression of bFGF showed no significant difference between the groups (P=0.655). Conclusions The levels of TGF-${\beta}1$, PDGF, and bFGF are altered by the silicone gel sheet treatment, which might be one of the mechanisms of action in scar prevention.

• Archives of Plastic Surgery
• /
• 제41권6호
• /
• pp.620-629
• /
• 2014

Keloid scars are often considered aesthetically unattractive and frustrating problems that occur following injuries. They cause functional and cosmetic deformities, displeasure, itching, pain, and psychological stress and possibly affect joint movement. The combination of these factors ultimately results in a compromised quality of life and diminished functional performance. Various methods have been implemented to improve keloid scars using both surgical and non-surgical approaches. However, it has proven to be a challenge to identify a universal treatment that can deliver optimal results for all types of scars. Through a PubMed search, we explored most of the literature that is available about the intralesional injection treatment of hypertrophic scars and keloids and highlights both current (corticosteroid, 5-fluorouracil, bleomycin, interferon, cryotherapy and verapamil) and future treatments (interleukin-10 and botulinum toxin type A). The reference lists of retrieved articles were also analysed. Information was gathered about the mechanism of each injection treatment, its benefits and associated adverse reactions, and possible strategies to address adverse reactions to provide reliable guidelines for determining the optimal treatment for particular types of keloid scars. This article will benefit practitioners by outlining evidence-based treatment strategies using intralesional injections for patients with hypertrophic scars and keloids.

• Medical Lasers
• /
• 제8권2호
• /
• pp.90-93
• /
• 2019

The treatment of keloid and hypertrophic scars (HTSs) remains one of the most difficult challenges, with a high recurrence rate regardless of the method of treatment. The latest trend in scar management is a combined approach using multiple modalities that are individualized to the patient and that would provide successful results for keloid and HTSs. There are previous reports that stromal vascular fraction (SVF) is effective for scar remodeling. Based on these reports, we introduced the concept of a combination treatment using SVF injection and fractional ablative CO₂ laser. In this report, we present a 21-year-old woman who was involved in a car accident. A defect on her foot was covered with a skin graft, but the scars became elevated, which turned out to be HTSs. She was treated with a fractional ablative CO₂ laser for five sessions. A month later, SVF injection and fractional ablative CO₂ laser were conducted simultaneously. The result of a year's follow-up showed a flattened scar with resolution of pigment deposition. In conclusion, the combination treatment for HTSs with SVF injection and ablative fractional CO₂ laser is one of the modalities to achieve an excellent outcome for treating HTS.

• Radiation Oncology Journal
• /
• 제15권3호
• /
• pp.269-276
• /
• 1997

목적 : 켈로이드와 비후성 반후에서 재발을 방지하기 위해 외과적 절제술후 방사선치료를 받은 환자를 대상으로 그에 대한 효과를 알아보고자 하였다. 방법 : 1987년 10월부터 1995년 4월까지 켈로이드로 수술후 방사선치료를 받은 106명의 환자 에서 167예를 대상으로 후향적 분석을 하였다. 켈로이드의 주된 발생원인으로는 수술이 83예$(49.2\%)$, 외상이 42예$(25.0\%)$ ear-piercing이 9예$(5.4\%)$, 화상이 9예$(5.4\%)$였다. 켈로이드의 위치별 분포로는 이개에 25예$(15.0\%)$, 그외 머리와 목이 81예$(48.5\%)$, 체간이 36예$(21.5\%)$, 사지가 25예$(15.0\%)$였다. 남자는 19명, 여자는 87명이였고 연령은 3세에서 70세였다(중앙값:32세). 방사선치료는 수술후 24시간 이태에 시행하였으며 6-8MeV의 전자선을 이용하여 총 조사선량은 400cGy에서 1900cGy까지 조사하였다(평균값: 1059cGy). 추적관찰 기간은 24개월에서 114개월 이었으며 중앙값은 49개월이었다. 결과 : 대상환자 106명의 환자에서 167예를 치료한 결과, 재발은 21예로 $12.6\%$의 재발율을 보였고, 1년 재발율은 $10.2\%$, 2년 재발율은 $11.4\%$였다. 재발된 병변에 있어서 수술후 12개월이 내에 재발된 경우는 전체의 $81\%$였다(17/21). 재발된 25예의 재발기간은 수술후 1개월에서 47개월까지였으며 평균재발기간은 9.6개월이였다. 재발된 부위를 살펴보면 이개에 2예$(1.2\%)$, 그외 머리와 목이 14예$(8.4\%)$, 체간이 4예$(2.4\%)$, 사지간 1예$(0.6\%)$로 나타났다. 재발에 영향을 미치는 예후인자에 연령. 성별, 분할조사 크기, 1회 조사량, 원인, 위치, 발생전 치료유무에 따라 분석한 결과 : 과거의 치료유무에서 치료경험이 없었던 군이 치료경험이 있었던 군보다 재발율이 낮았으며$(11.0\%\;vs.\;22.6\%)$ 과거와 치료유무만이 통계적인 유의성이 있었다(P=0.04). 치료에 따른 합병증으로 특이한 사항은 없었다. 결론 : 켈로이드와 비후성 반흔 환자에서 재발 발지를 위한 수술후 방사선치료는 비교적 안전하고 효과적이였다. 그러나 추후 수술후 방사선치료의 역할을 보다 더 정확히 평가하기 위해서는 비교 연구와 전향적인 연구가 필요할 것으로 사료된다.