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Plastic surgeon

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Surgical treatment of keloid and hypertrophic scars

Alexey Kryvenko, medical expert
Last reviewed: 04.07.2025

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Excision of a keloid scar in combination with conservative treatment is advisable in cases where the keloid scar has small transverse dimensions on one side and protrudes significantly above the skin surface on the other. The technique of excision of a keloid scar has the following features:

the surgical intervention must be carried out in such a way that no instruments are used on the skin itself;
tissue infiltration with an anesthetic solution is carried out so that the needle injection points are located on those areas of the skin that will be removed; in people prone to keloidosis, the needle injection is made only along the line of the future incision;
the incision is made with a sharp scalpel to the depth of the subcutaneous layer in one movement so that the plane of the dermal incision is as smooth as possible;
cutting skin with scissors is prohibited;
when preparing the edges of the wound, they are lifted with hooks only by the layer of subcutaneous fat;
The wound can be sutured only when its edges can be easily brought together;
if it is impossible to suture the wound in a line, free skin grafting is used;
additional incisions for flap plastic surgery on the feeding pedicle are not recommended;
It is prohibited to apply interrupted sutures to the skin; only continuous subcutaneous sutures are used; for more precise alignment of the edges of the wound, strips of adhesive tape (Steri-strip) are used;
in the postoperative period, tissue immobilization in the intervention area is necessary;
1 month after the operation, a course of Kenalog injections begins, after which they begin external use of Epiderm plates.

In the treatment of 32 patients using this comprehensive approach, consistently good results were achieved in 9.2% of cases.

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