DIFFERENT SCARS AND THEIR MANAGEMENT

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1 DIFFERENT SCARS AND THEIR MANAGEMENT Dr R. Newaj Specialist Dermatologist MBBCh (Wits) FCDerm (SA) Arwyp medical centre, Kemptonpark and Intercare Irene, Centurion

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3 COMMON CAUSES OF WOUNDS AND INJURIES OPERATIONS BURNS SCARS SKIN DISEASES- LUPUS, MORPHEA, CHICKENPOX ACNE VULGARIS ACNE KELOIDALIS NUCHAE

4 TYPES OF WOUND REPAIR Different types of wounds heal in different manners, depending on the size of the skin defect and measures taken to aid the process 1. Primary intention: Apposition of skin surfaces of fresh wounds can involve suturing, skin flaps, grafts 2. Secondary intention: Wounds are left open and allowed to heal naturally by epithelialization with granulation and contraction 3. Tertiary intention: The wounds are closed a few days later

5 PHASES OF WOUND HEALING INFLAMMATORY PROLIFERATIVE MATURATION REMODELLING

6 Sequence of Molecular and Cellular Events in Skin Wound Healing (courtesy G Schultz) Four Phases of Healing 1. Inflammation 2. Proliferative 3. Maturation 4. Remodeling Vascular Scar Epithelial Scar Clotting Response Inflammation Formation Healing Contraction Remodeling 23-Jan-14

7 Provisional Wound Matrix (Fibrin) is Replaced by Scar Tissue (Collagen & BM) Provisional wound matrix (clot, fibrin) is replaced by new collagen, elastin, glycoproteins, and basement membrane that are synthesized by fibroblasts migrating into the wound. TGFb and CTGF are the dominant growth factors that stimulate scar formation. 23-Jan- 14

8 ABNORMALITIES IN WOUND HEALING 1. Inadequate wound healing 2. Excessive wound healing

9 INADEQUATE WOUND HEALING A) General factors: Age ( decrease protein turnover, diabetes etc) Malnutrition ( vit C,A, Zinc, Copper) Systemic diseases( Anaemia, diabetes, neuropathy) Cytotoxic drugs and steroids Smoking Genetic conditions( marfan s Ehlers-Danlos

10 B: LOCAL FACTORS: Site- Wounds of head, neck and hands always heal wellgood blood supply and abundant adnexal cells Tension on tissues- inhibits blood supply leading to delayed healing Local infection Poor blood supply Rest Foreign body Local radiation Occlusion ( decrease chance of infection and keep it moist) Presence of dry eschar

11 EXCESSIVE WOUND HEALING KELOIDS

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13 MANAGEMENT OF KELOIDS Prevention( No wound tension, sillicone occlusive dressings, sutures) Do not treat if not needed Excission Cryotherapy Injection of steroids or 5-fluorouracil Radiotherapy

14 HYPERTROPHIC SCARS This is a raised, red scar, similar in appearance to a keloid but it does not extend over the injury site. This scar is formed when there are high areas of tension with pulling forces in many directions e.g. sternum and back.

15 SCAR A scar is formed when the deep, thick layer of the dermis is damaged. The scar never completely goes away, but can improve with time and various other factors A good scar is thin, flat and pale with a minimal trace of the original injury. A bad scar is raised or recessed, dark in colour and/or extends over the boundary of the original injury. 75% of all scars will go through hypertrophic or exaggerated scarring if not adequately managed. Thus every scar deserves scientific management.

16 TYPES OF SCAR All wounds will form a scar Excessive wound healing results in two types of scars: either Keloids or Hypertrophic scarring Other types of scars include: Stretched scars, contractures, depressed(sunken) scars, atrophic Inadequate wound healing results in a skin ulcer or chronic wound

17 TYPES OF SCAR Atrophic Hypertrophic Keloid 17

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19 ACNE SCARS

20 STRETCHED SCARS Increased tension in one direction on the skin or scar area, e.g. in injuries such as the on joints, e.g. elbow, knee etc Scars from excisional wounds on the trunk and limbs often stretch too. Steps to avoid excessive tension across the wound will be rewarded with narrower scars.

21 CONTRACTURE SCARS When the skin is burned, a scar will form causing tightening of the skin. This scar may go deeper to affect muscles and nerves. If the scar limits movements of the body (usually over joints) it is referred to as a scar contracture.

22 DEPRESSED OR SUNKEN SCARS A scar is formed as a sunken recess in the skin giving it a pitted appearance.

23 PREVENTION OF SCARS 1. Do not perform unnecessary procedures 2. Treat diseases early ( Acne, Chicken pox) 3. Good wound alignment and prevention of tension 4. Sillicone gels from the beginning( Hydrates and help the wound to heal faster), tape keep the collagen well aligned and helps in faster healing 5. Prevention of infection

24 Thank you

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