بسم الله الرحمن الرحيم وقل رب زدنى علما. SCAR SCAR AND AND KELIOD...
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Transcript of بسم الله الرحمن الرحيم وقل رب زدنى علما. SCAR SCAR AND AND KELIOD...
الرحمالرحماللهاللهبسمبسمالرحيمالرحيمنن
علما زدنى رب علما وقل زدنى رب وقل
SCARSCAR
ANDAND
KELIODKELIOD
Dr. Imrana AzizDr. Imrana AzizAssistant ProfessorAssistant Professor
Surgical Deptartment Surgical Deptartment
Wound HealingWound Healing I. Inflammatory PhaseI. Inflammatory Phase (Immediate to 2-5 (Immediate to 2-5
days)days)
A) HemostasisA) Hemostasis Vasoconstriction Vasoconstriction Platelet aggregation Platelet aggregation
B) Inflammation B) Inflammation Vasodilation Vasodilation PhagocytosisPhagocytosis
II. Proliferative PhaseII. Proliferative Phase ( (2 days to 3 2 days to 3
weeks)weeks)
A) GranulationA) Granulation Fibroblasts produce collagen Fibroblasts produce collagen Fills defect and produces new capillaries Fills defect and produces new capillaries
B) ContractionB) Contraction
C) EpithelializationC) Epithelialization
III. Remodeling PhaseIII. Remodeling Phase (3 weeks to 2(3 weeks to 2 years) years)
A) Increases tensile strength to A) Increases tensile strength to wounds wounds
B) Organised, flatteed scar produceB) Organised, flatteed scar produce
ExudateExudate
ScabScab
Fine lineFine line
RedRed
RaisedRaised
ItchyItchy
TenderTender
contractioncontraction
PalePale
FlatFlat
QuietQuiet
contractivecontractive
1-6 weeks1-6 weeks
HealingHealing2 wks- 2yrs2 wks- 2yrs
RemodelinRemodelingg
6mths-2yrs6mths-2yrs
MaturationMaturation
Scars (Cicatrix)Scars (Cicatrix)
A scar is a permanent patch of skin A scar is a permanent patch of skin that grows over a that grows over a woundwound. (after a . (after a cut, scrape, burn or sore, surgery cut, scrape, burn or sore, surgery cuts, infections, skin conditions like cuts, infections, skin conditions like acneacne).).
Factor for ideal scarFactor for ideal scar::Intrinsic:Intrinsic:Age: old personAge: old personChronic diseaseChronic diseaseAbnormal collagen syndrom: ehlers –Abnormal collagen syndrom: ehlers –
danlosdanlosMalnutritionMalnutritionSmoking Smoking Obesity Obesity
Extrinsic:Extrinsic:
Achieve quiet primary healingAchieve quiet primary healing
Clean incised edges,no tissue losSClean incised edges,no tissue losS
Avoid dehiscence or infectionAvoid dehiscence or infection
Minimise tensionMinimise tension
Factor for ideal scarFactor for ideal scar
Align scar with wrinkle, injection or Align scar with wrinkle, injection or relaxed skin tension linerelaxed skin tension line
Site: eyelids, genitalia, palm Site: eyelids, genitalia, palm vermilion vermilion
Fine lax skinFine lax skin
Importance of line of langer`sImportance of line of langer`s::These are tension lines, due to the These are tension lines, due to the
patterens of arrangement of collegen patterens of arrangement of collegen fiber in dermis.fiber in dermis.
Skin creases, wrinkles of ageing Skin creases, wrinkles of ageing parallel with tension lines.parallel with tension lines.
Incisions made along skin tension Incisions made along skin tension lines heal with minimum scarring.lines heal with minimum scarring.
Types of ScarTypes of Scar Normal scarNormal scar Widened scarWidened scar Atrophic scarAtrophic scar Hypertrophic scarHypertrophic scar Keliod scarKeliod scar
Normal scar:Normal scar:Forms after 2-3 wks.Forms after 2-3 wks.Appear flatten to a linear white line.Appear flatten to a linear white line.
Widened scarWidened scar:: occurs in sites of higher.occurs in sites of higher.
Atrophic scarAtrophic scar::Acne vulgaris, varcella infection , Acne vulgaris, varcella infection ,
immunization sites leave atrophic immunization sites leave atrophic scarscar
Hypertrophic ScarHypertrophic Scar
These are overgrowth of fibrous scar These are overgrowth of fibrous scar tissue that remains within boundaries tissue that remains within boundaries of original wound and tend to regress of original wound and tend to regress spontaneouslyspontaneously
Keliod:Keliod:
scar in which there is overgrowth of scar in which there is overgrowth of dense fibrous tissue beyond the dense fibrous tissue beyond the wound limit. They do not regress wound limit. They do not regress spontanously.spontanously.
AetiologyAetiology The cause is unknownThe cause is unknownthese scars seem to function these scars seem to function
autonomously resulating in an autonomously resulating in an increase in the production of increase in the production of fibroblastic collagen and fibroblastic collagen and metaloproteinase and dec: in metaloproteinase and dec: in collagen degradation collagen degradation
EpidemiologyEpidemiology common in people with darker skins, common in people with darker skins,
especially African-American races.especially African-American races.
The peak age is 10-30 years, The peak age is 10-30 years, keloids are less common at the keloids are less common at the
extremes of age.extremes of age.
There may be a family history of There may be a family history of tendency to develop keloidstendency to develop keloids
Presentation:Presentation:
SymptomsSymptoms Cosmetic Cosmetic Tender Tender PainfulPainful Itch Itch Burning sensation. Burning sensation.
History of trauma :accidental, surgical or History of trauma :accidental, surgical or cosmetic, Burn scars or infected lesions, cosmetic, Burn scars or infected lesions, including acne, are more likely to form including acne, are more likely to form keloids. keloids.
Clinical featuresClinical features:: Sites : the most common areas are sternum, Sites : the most common areas are sternum,
shoulder, earlobe and cheekshoulder, earlobe and cheek Raised and irregularRaised and irregular Beyond the original line of trauma. Beyond the original line of trauma. rubbery texture. rubbery texture. It is red in the early stages, but becomes It is red in the early stages, but becomes
brown or pale with age. brown or pale with age. No hair follicles or sweat glands within the No hair follicles or sweat glands within the
scar. scar. Keloids over a joint can contract and restrict Keloids over a joint can contract and restrict
movement. movement. Clinical course: The natural history is Clinical course: The natural history is
variable: variable:
It is red in the early stages, but It is red in the early stages, but becomes brown or pale with age. becomes brown or pale with age.
No hair follicles or sweat glands No hair follicles or sweat glands within the scar. within the scar.
Keloids over a joint can contract and Keloids over a joint can contract and restrict movement. restrict movement.
Clinical course: The natural history is Clinical course: The natural history is variable: variable:
Comparison of hypertophic and Comparison of hypertophic and keliodkeliod
featurefeature Hypertrophic Hypertrophic scarscar
Keliod scarKeliod scar
GenetiGeneticc
RaceRace
SexSex
AgeAge
borderborderss
Not familialNot familial
Not relatedNot related
F = MF = M
ChildrenChildren
Remains Remains whithin wound whithin wound
May be familialMay be familial
Black > whiteBlack > white
F > MF > M
10-30 yrs10-30 yrs
Outgrows wound Outgrows wound areaarea
featurefeature HYPERTROPHICHYPERTROPHIC KELIODKELIOD
Natural Natural historyhistory
SiteSite
EtiologyEtiology
Affect of Affect of prgnancprgnancyy
Subsides with Subsides with timetime
Flexor surfaceFlexor surface
Related to Related to tensiontension
Related to poor Related to poor surgical surgical technique.technique.
Not affacted Not affacted
Rarely subsidesRarely subsides
Sternum, Sternum, shoulder, faceshoulder, face
UnknownUnknown
Inc: risk in Inc: risk in pregnancy and pregnancy and pubertypuberty
Hypertrophic Hypertrophic Keliod Keliod
Some immunological Some immunological abnormalitiesabnormalities
Electron microscope Electron microscope shows thin organized shows thin organized collagen bundles.collagen bundles.
Not related to Not related to immunological immunological abnormalitiesabnormalities
Electron microscope Electron microscope shows thick, shows thick, disorganized disorganized collagen.collagen.
Management:Management:There is no universal treatment for There is no universal treatment for
abnormal scar.abnormal scar.
Medical treatmentMedical treatment::pressure dressingpressure dressingcompressive dressingcompressive dressingsilicone gel pad. silicone gel pad.
cortisone injectionscortisone injections
RadiotherapyRadiotherapy
CryotherapyCryotherapy
Laser treatmentLaser treatment
interpheron interpheron
Cytotaxic drugsCytotaxic drugs
Other therapiesOther therapies vit:Evit:E allantionallantion
Surgical treamentSurgical treament Z plastyZ plasty
Y-V advancement flapY-V advancement flap
Intensive Physiotherapy Intensive Physiotherapy
Therapeutic scaring Therapeutic scaring
Many societies done the Many societies done the scarification as sign of beauty or scarification as sign of beauty or decoration. decoration.