## Scar Types ### Hypertrophic scars (HTS) - Elevated scar that **remain within the wound borders** - contains collagen III parallel to epidermal surface with high counts in myofibroblasts and extracellular [[collagen]] - More common in areas of tension and flexor surfaces - Recurrence less likely than keloid after excision ![[Pasted image 20250118145246.png]] ### Keloid scars - Elevated scar that grows outside the wound borders - hypocellular [[collagen]] bundles, mainly type I and III - More common with deep injuries, esp in those with genetic and endocrine predisposition - May grow during puberty and pregnancy - Recurrence more likely than HTS after excision ![[Pasted image 20250118145258.png]] ![[Pasted image 20250118145045.png]] ^[Sidle DM, Kim H. Keloids: prevention and management. _Facial Plast Surg Clin North Am_. 2011;19(3):505-515. doi:[10.1016/j.fsc.2011.06.005](https://doi.org/10.1016/j.fsc.2011.06.005)] ^[Chike-Obi CJ, Cole PD, Brissett AE. Keloids: pathogenesis, clinical features, and management. _Semin Plast Surg_. 2009;23(3):178-184. doi:[10.1055/s-0029-1224797](https://doi.org/10.1055/s-0029-1224797)] ### Widened scars - Depressed and widened scar from wound tension during the maturation phase of [[Wound Healing]] ![[Pasted image 20250118145330.png]] ### Fetal healing - Potentially no scar for wound during the first 2 trimesters ## Management 1. Silicone sheeting for 1 mo after [[epithelialization]]^[Mustoe TA, Cooter RD, Gold MH, Hobbs FDR, Ramelet AA, Shakespeare PG, Stella M, Téot L, Wood FM, Ziegler UE, International Advisory Panel on Scar Management. International clinical recommendations on scar management. _Plast Reconstr Surg_. 2002;110(2):560-571. doi:[10.1097/00006534-200208000-00031](https://doi.org/10.1097/00006534-200208000-00031)] 1. unknown mechanism, e.g. may increase collagenase activity in addition to hydration and temperature 3. Corticosteroid injections 1. risk subcutaneous atrophy, telangiectasia, pigment changes 4. Weak evidence: pressure therapy/ massage to reduce scar thickness^[Shin TM, Bordeaux JS. The role of massage in scar management: a literature review. _Dermatol Surg_. 2012;38(3):414-423. doi:[10.1111/j.1524-4725.2011.02201.x](https://doi.org/10.1111/j.1524-4725.2011.02201.x)] 5. No evidence: topical vitamin E (may cause contact dermatitis)^[Khoo TL, Halim AS, Zakaria Z, Mat Saad AZ, Wu LY, Lau HY. A prospective, randomised, double-blinded trial to study the efficacy of topical tocotrienol in the prevention of hypertrophic scars. _J Plast Reconstr Aesthet Surg_. 2011;64(6):e137-145. doi:[10.1016/j.bjps.2010.08.029](https://doi.org/10.1016/j.bjps.2010.08.029)], topical onion extract (e.g. Mederma)^[Chung VQ, Kelley L, Marra D, Jiang SB. Onion extract gel versus petrolatum emollient on new surgical scars: prospective double-blinded study. _Dermatol Surg_. 2006;32(2):193-197. doi:[10.1111/j.1524-4725.2006.32045.x](https://doi.org/10.1111/j.1524-4725.2006.32045.x)] #clinicalscience