Hypertrophic scar and keloid

,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Hypertrophic scar and keloid,Wound healing process,Inflammation,Proliferation,Remodeling,Inflammation phase,Immediate to 2-5 day,Hemostasis,: vasoconstriction,: platelet aggregation,: clot formation,: cytokine,release,Inflammation phase (cont.),Acute phase (24-48 hr.),: Neutrophil infiltration,: Phagocytosis foreign debris and bacteria,Late phase,: Monocyte infiltration,: Clear residual pathogen, cell and matrix debris,Proliferation phase,2 day to 3 wk.,Granulation and angiogenesis,: fibroblast migration and proliferation,: produce new collagen and capillary,Contraction,: wound edge pull together to reduce defect,Proliferation phase (cont.),Epithelialization,: keratinocyte proliferation,Remodeling phase,3 wk. to 2 yr.,New collagen forms which increase tensile strength to wound,Balance of matrix degradation and collagen synthesis,Scar tissue is only 80%,as strong as original tissue,Type of wound,Partial thickness wound,Full thickness wound,Partial thickness wound,Involve epidermis and superficial dermis,Sparing adnexal structure,: hair follicle, sweat gland, sebaceous gland,Re- epithelialization from edge of wound and adnexal structure,Complete healing with minimal or no scar,Pigmentary change may occur,Full thickness wound,Involve deep dermis,Adnexal structure destruction,Re- epithelialization only from epithelium margin,Contraction facilitate re- epithelialization by bringing wound edge together,Heal with scar,Type of scar,Normal scar,: normal wound healing process,Abnormal scar,: Multiple disturbance in wound healing process,: Excessive collagen production,: Reduce collagen degradation,Keloid,Firm, irregularly shape,Thin epithelium,Caused by surgical procedure, burn, trauma, inflammation,Spread beyond the limit of original injury,Appear within wk. or yr.,Keloid (cont.),Persist over time,Early lesion : red, tender, rubbery, may be telangiectatic,Old lesion : brown, pruritic, pain, hyperesthesia,Varying in size and number,Keloid (cont.),Most common in chest, neck, ear, extremities,Rarely on face, palm, sole,Hypertrophic scar,Linear, red, raised firm scar,Confined to the original injury site,Pruritic, but not pain or hyperesthesia,Common affect under constant pressure and stretching area,Usually arise within 1 month of injury,Hypertrophic scar (cont.),Spontaneous improvement during first 6 month,Treatment,Non laser treatment,: Occlusion with silicone sheet,: Intralesional steroid injection,: Intralesional 5-FU,injection,: Topical imiquimod,Treatment (cont.),Laser treatment,: CO2 discontinue,: Er:YAG,: PDL,: Q-switched Nd:YAG 532nm,: Fraxel,Ideal patient for laser scar revision,Light skinned type,Scar 1 yr.,Red, raised scar,Mechanism of PDL,Microvascular destruction,Suppression of fibroblast proliferation,3-5 session,57-83% improvement after 1-2 treatment session,Burning or itching sensation after procedure and subsides within a couple day,PDL (cont.),Initial improvement in erythema and,symptom within first month after first session,Most common side effect is purpura,Better outcome if early treatment within first month after injury,PDL (cont.),No significant different between PDL alone or combine with intralesional injection,Fraxel,Irreversible destroy dermal vascular,Collagen remodeling in microwound,Improve texture, contour, appearance,