Management of Scars Flashcards
Keloids: rarely spontaneously regress
T
Keloids familial predisposition
common
T
TGF-beta excess contributes to fibroproliferative scar formation (keloids and hypertrophic scar)
T
mature scar, which has approximately 80% of the tensile strength of normal unwounded skin, occurs
between 6 and 18 months after wounding
T
Keliod result from relatively minor injury or insult
T
Partial or total resolution or regression can spontaneously
occur IN Hypertrophic scars
T
Decreased collagen content and production in hypertrophic scar
T
massage
can aid in the flattening and softening ofscars and limiting some scar
contractures
T
Professional
massage therapists appear to be of benefit in scarring related to burn
T
The Mechanism of action Silicone Gel appears to be that oftemperature increase, or by
any chemical effects of absorbed silicone
F appears to be the occlusive nature of silicone dressing and epithelial hydration
Compression garments are recommended prophylactically in burn injury after
extensive skin grafting and/or if spontaneous wound healing
requires longer than 10 to 14 days
T
Pressure requirements is mandatory for pressure garment work
F Pressure requirements for effectiveness have not been established
although 15 to 25 mm Hg is the
target pressure reported
t
Effectiveness of pressure in keloid may be
up to 80% following complete surgical excision
T
Steroid pretreatment
for keloids followed by surgical excision and follow-up postoperative
injections produce reported cure rates of up to 80%
T
Keloid excision
followed by radiation therapy within 24 to 48 hours either as a
single dose or as multiple doses can reduce recurrence and lead
to cure rates between 67% and 98%
T
MOA OF radiation in keloid
Radiation damages keloid fibroblasts, affecting collagen production and structure
Radiation monotherapy is not
effective
T
Concern for malignancy due to radiation
therapy is advisable, especially in the pediatric age patient or in
areas prone to radiation-induced carcinomas, such as thyroid and
breast
T
Radiation therapy for refractory/intractable hypertrophic scarring has been reported as effective
T
soft tissue fibrosis
as encountered with higher doses of radiation therapy is common
F soft tissue fibrosis
as encountered with higher doses of radiation therapy is not likely
Topical cryotherapy may achieve initial positive results in hypertrophic scars and keloid treatment; subsequent recurrence rates are
high
T
intraoperative injection of botulinum
toxin type A, 10 U/cm in a split-scar randomized trial improves surgically
incisional scars
T
mechanism of action of botulinum toxin
is inhibition of TGF-beta
1 and cell cycle interaction, diminishing fibroblast cell functions/
regulation
Vitamin E and onion extract have littleclinical evidence in scar management
T
Hypertrophic scars, treated early with laser , less
than I-year while still erythematous, responded better than those of
more mature age
T
Increased number of mast cells in hypertrophic scar
T
Recommendation for treatment is to wear the silicone gel dressing for 12 to 24 hours per day for
2 to 3 months at the onset of visible scar abnormality
T
Treatments for scar prevention as well
as established hypertrophic scar therapy indicated response rates in
the range of 70% with PDL laser
T
There is growing
subjective evidence to suggest that fat grafting may become a mainstay for scar treatment
T
