Rudolph R
Clinics in plastic surgery. Date of publication 1987 Apr 1;volume 14(2):253-60.
1. Clin Plast Surg. 1987 Apr;14(2):253-60.
Wide spread scars, hypertrophic scars, and keloids.
Rudolph R.
Patients with a wide scar may complain of having a "keloid," yet have a
hypertrophic or a wide spread scar. The plastic surgeon should make the
appropriate clinical diagnosis, because therapy varies depending on the condition
present. A wide spread scar is best treated with excision and closure. A buried
dermal flap may help to prevent recurrence, which is nevertheless likely to some
degree. A hypertrophic scar can be distinguished from a keloid on clinical
grounds. Although both may be red, nodular, and itchy, the keloid overgrows the
original wound boundary and is much more likely to recur after surgical excision.
Nonsurgical treatment of hypertrophic scars and keloids is similar, using
repeated intralesional injections of Kenalog 40 mg per cc and sustained pressure
on the lesion when possible. Surgical treatment differs for hypertrophic scars or
keloids. Scar excision and closure, and selective Z-plasty, may be used in
hypertrophic scars. In keloids, aggressive surgery is usually avoided, unless the
lesion has a narrow pedicle. Surgery of keloids should be accompanied by intra-
and postoperative Kenalog-40 injections, and on occasion by sustained pressure.
Very large keloids may be resistant to medical management, and too aggressive for
surgery owing to a high likelihood of recurrence. These difficult lesions serve
as the impetus for continued biochemical and tissue culture research, seeking a
biochemical means of control keloids.
PMID: 3581659 [Indexed for MEDLINE]
Appears in following Topics:
