Hypertrophic scar and keloid.ppt

Hypertrophicscarandkeloid Woundhealingprocess InflammationProliferationRemodeling Inflammationphase Immediateto2 5dayHemostasis vasoconstriction plateletaggregation clotformation cytokinerelease Inflammationphase cont Acutephase 24 48hr Neutrophilinfiltration PhagocytosisforeigndebrisandbacteriaLatephase Monocyteinfiltration Clearresidualpathogen cellandmatrixdebris Proliferationphase 2dayto3wk Granulationandangiogenesis fibroblastmigrationandproliferation producenewcollagenandcapillaryContraction woundedgepulltogethertoreducedefect Proliferationphase cont Epithelialization keratinocyteproliferation Remodelingphase 3wk to2yr NewcollagenformswhichincreasetensilestrengthtowoundBalanceofmatrixdegradationandcollagensynthesisScartissueisonly80 asstrongasoriginaltissue Typeofwound PartialthicknesswoundFullthicknesswound Partialthicknesswound InvolveepidermisandsuperficialdermisSparingadnexalstructure hairfollicle sweatgland sebaceousglandRe epithelializationfromedgeofwoundandadnexalstructureCompletehealingwithminimalornoscarPigmentarychangemayoccur Fullthicknesswound InvolvedeepdermisAdnexalstructuredestructionRe epithelializationonlyfromepitheliummarginContractionfacilitatere epithelializationbybringingwoundedgetogetherHealwithscar Typeofscar Normalscar normalwoundhealingprocessAbnormalscar Multipledisturbanceinwoundhealingprocess Excessivecollagenproduction Reducecollagendegradation Keloid Firm irregularlyshapeThinepitheliumCausedbysurgicalprocedure burn trauma inflammationSpreadbeyondthelimitoforiginalinjuryAppearwithinwk oryr Keloid cont PersistovertimeEarlylesion red tender rubbery maybetelangiectaticOldlesion brown pruritic pain hyperesthesiaVaryinginsizeandnumber Keloid cont Mostcommoninchest neck ear extremitiesRarelyonface palm sole Hypertrophicscar Linear red raisedfirmscarConfinedtotheoriginalinjurysitePruritic butnotpainorhyperesthesiaCommonaffectunderconstantpressureandstretchingareaUsuallyarisewithin1monthofinjury Hypertrophicscar cont Spontaneousimprovementduringfirst6month Treatment Nonlasertreatment Occlusionwithsiliconesheet Intralesionalsteroidinjection Intralesional5 FUinjection Topicalimiquimod Treatment cont Lasertreatment CO2discontinue Er YAG PDL Q switchedNd YAG532nm Fraxel Idealpatientforlaserscarrevision LightskinnedtypeScar 1yr Red raisedscar MechanismofPDL MicrovasculardestructionSuppressionoffibroblastproliferation3 5session57 83 improvementafter1 2treatmentsessionBurningoritchingsensationafterprocedureandsubsideswithinacoupleday PDL cont InitialimprovementinerythemaandsymptomwithinfirstmonthafterfirstsessionMostcommonsideeffectispurpuraBetteroutcomeifearlytreatmentwithinfirstmonthafterinjury PDL cont NosignificantdifferentbetweenPDLal