Management of incisional scar is intimately connected to stages of wound healing. The management of an elective surgery patient begins with a thorough informed consent process in which the patient is made aware of personal and clinical circumstances that cannot be modified, such as age, ethnicity, and previous history of hypertrophic scars. In scar prevention, the single most important modifiable factor is wound tension during the proliferative and remodeling phases, and this is determined by the choice of incision design. Traditional incisions most often follow relaxed skin tension lines, but no such lines exist in high surface tension areas. If such incisions are unavoidable, the patient must be informed of this ahead of time. The management of a surgical incision does not end when the sutures are removed. Surgical scar care should be continued for one year. Patient participation is paramount in obtaining the optimal outcome. Postoperative visits should screen for signs of scar hypertrophy and has a dual purpose of continued patient education and reinforcement of proper care. Early intervention is a key to control hyperplastic response. Hypertrophic scars that do not improve by 6 months are keloids and should be managed aggressively with intralesional steroid injections and alternate modalities.
Cicatrix/*prevention & control/surgery ; Cicatrix, Hypertrophic/prevention & control ; Humans ; Keloid/prevention & control/radiotherapy ; Sebaceous Glands/physiology ; Skin/physiopathology ; Wound Healing

The management of local wounds is one of the key steps in the treatment of trauma and burns. Based on the advance in wound management in recent years, we emphasize the importance of paying much attention to study on mechanisms, prevention and treatment in local chronic wounds and hypertrophic scar. Also, the application of some high-technique methods may help enhancing the wound healing velocity and quality after injury.
Burns ; surgery ; Cicatrix, Hypertrophic ; prevention & control ; Humans ; Wound Healing ; Wounds and Injuries ; surgery

Wound repair is the critical issue in burn injury management. Optimal coverage or regeneration of skin tissue is still a great challenge. In this review, we summarize the current achievements in the fields of immune tolerance induction, skin tissue regeneration, and hypertrophic scar control, which might provide new viewpoints and research direction for diagnosis and treatment of burn wounds.
Burns ; surgery ; Cicatrix, Hypertrophic ; prevention & control ; surgery ; Humans ; Regeneration ; Skin Transplantation

PURPOSE: Hypertrophic scarring and depression are the principal problems of burn rehabilitation. This study was done to verify the effects of skin rehabilitation massage therapy (SRMT) on pruritus, skin status, and depression for Korean burn survivors. METHODS: A pretest-posttest design using a nonequivalent control group was applied to examine the effects of SRMT for 3 months in a group of 18 burn survivors. The major dependent variables-including pruritus, objective and subjective scar status, and depression-were measured at the beginning and at the end of the therapy to examine the effects of SRMT. RESULTS: Burn survivors receiving SRMT showed reduced pruritus, improved skin status, and depression. The remaining scar also showed improvement in skin pigmentation, pliability, vascularity, and height (compared to the surrounding skin) as measured on the Vancouver Scar Scale (VSS). CONCLUSIONS: The findings demonstrate that SRMT for burn survivors may improve their scars both objectively and subjectively, and also reduce pruritus and depression.
Adult ; Burns/complications/*rehabilitation ; Cicatrix, Hypertrophic/etiology/*prevention & control ; Depressive Disorder/etiology/*prevention & control ; Female ; Humans ; Male ; *Massage ; Pruritus/etiology/*prevention & control

OBJECTIVETo assess the outcome of large facial defect reconstruction with "partition" pre-expanded cervico-scapulo-dorsal flaps (CSDF) based on the superficial cervical artery (SCA).

METHODSSurgical course consisted of 3 stages. In stage I, a skin flap was designed along the axis of SCA according to the facial defect and an expander was implanted in the cervico-scapulo-dorsal region by means of "partition" expansion. The expanders were implanted beside the flap axis and beneath the posterior half of flaps so as to expand only half area of the flap. During the stage II, expanders were injected with saline regularly for continuous expansion. In stage III, the pre-expanded CSDFs were transferred to cover the facial defect of which the CSDFs included about half of non-expanded area.

RESULTSFrom November of 2008 to December of 2013, 15 patients with facial hypertrophic scar or scar contracture were reconstructed with pre-expanded CSDF based on the SCA. The expansion lasted for 3 to 4 months, and the expanded volume varied from 680 to 960 ml. One case of 4.0 cm x 1.5 cm epidermal flap necrosis occurred and healed subsequently with superficial scar; and another case of blister formation in the distal part of flap was found, which recovered without scar; the other 13 flaps survived without complications. After a follow-up for 12 to 38 months( average 26. 2 months), patients regained satisfactory appearance of face, with no obvious hypertrophic scar in the donor site.

CONCLUSIONSPartition preexpanded CSDF based on the SCA is a good choice for large facial defect reconstruction, and the partition expansion is an effective strategy for prevention of venous congestion.

Arteries ; Back ; Cicatrix, Hypertrophic ; surgery ; Face ; blood supply ; surgery ; Humans ; Hyperemia ; prevention & control ; Surgical Flaps ; blood supply ; transplantation ; Tissue Expansion

OBJECTIVETo investigate the feasibility of prevention and treatment of early scar through observing the effect of feeding immunosuppressive drug cyclophosphamide on rabbit ears hypertrophic scar tissue in early stage.

METHODSThirty-two Rabbit ears were used to establish animal models for hypertrophic scar and randomly divided into four groups: group of distilled water (A), group of cyclophosphamide 5 mg x kg(-1) x d(-1) (B), group of 10 mg x kg(-1) x d(-1) (C), group of 30 mg x kg(-1) x d(-1) (D). Before animal models were built and after administration for 14 days, 28 days, leukocytes and lymphocytes were detected. After 28 days, specimens were harvested and underwent HE staining and VG staining in order to assess HI, NA, AA value changes. The data (HI, NA, AA) from each group were compared by analysis of variance, and the variance for the rank sum test when missing.

RESULTSOn the 14th day, the number of leukocytes in group A, B, C, D were (8.62 +/- 0.58) x 10(9)/L, (4.48 +/- 0.41) x 10(9)/L, (2.7 +/- 0.26) x 10(9)/L, (1.33 +/- 0.27) x 10(9)/L; the number of lymphocytes in group A, B, C, D were (3.11 +/- 0.21) x 10(9)/L, (1.67 +/- 0.16) x 10(9)/L, (0.42 +/- 0.10) x 10(9)/L, (0.40 +/- 0.09) x 10(9)/L. On the 28th day, the number of leukocytes in group A, B, C, D was (8.63 +/- 0.53) x 10(9)/L, (5.10 +/- 0.27) x 10(9)/L, (3.10 +/- 0.26) x 10(9)/L, (1.98 +/- 0.20) x 10(9)/L; the number of lymphocytes A, B, C, D was (3.06 +/- 0.16) x 10(9)/L, (2.08 +/- 0.14) x 10(9)/L, (0.96 +/- 0.19) x 10(9)/L, (0.14 +/- 0.07) x 10(9)/L. On the 14th day and 28th day, the number of leukocytes and lymphocytes in experimental groups was reduced, showing a negative relation with cyclophosphamide dose (P < 0.05). The HI in group of A, B, C, D was 3.02 +/- 0.24, 2.59 +/- 0.43, 2.06 +/- 0.19, 1.63 +/- 0.11; the AA was 40.49 +/- 2. 07, 35.29 +/- 1.99, 28.36 +/- 1.87, 24.99 +/- 1.82; the NA was 4570.5 +/- 259.3, 4222.5 +/- 199.6, 3540.3 +/- 170.3, 3341.4 +/- 228.8. The difference in HI, AA, NA between control group and any of the experimental groups was statistically significant (P < 0.01). Each group, with the dose increased, except NA content of group C and D, the HI, AA, NA was more smaller, negative correlation, the difference was statistically significant (P < 0.05).

CONCLUSIONSFeeding cyclophosphamide can inhibit leukocytes and lymphocytes number, so as to inhibit the proliferative activity of hypertrophic scar. It has significant effect on prevention of hypertrophic scar on rabbit ears in early stage.

Animals ; Cicatrix, Hypertrophic ; drug therapy ; prevention & control ; Cyclophosphamide ; pharmacology ; Ear ; pathology ; Female ; Leukocyte Count ; Leukocytes ; drug effects ; Lymphocyte Count ; Lymphocytes ; drug effects ; Male ; Rabbits