Correction of keloid scars

Conservative treatment. In the history of the treatment of keloid and hypertrophic scars, a large number of methods have been suggested that have had a certain effect, but have not led to a reliable solution to the problem. Currently, the most common types of treatment for hypertrophic and keloid scars.

X-ray therapy. The dose of irradiation depends on the size of the scar. B.Cosman et al. Offer the most effective average dose of 800 P 4 times for 4-8 weeks. EKVasilyeva, LI Krikun and VFBol'shakov used the average dose of 1000 P once a month, the course of treatment 10 sessions. Treatment is successful in 80% of cases.

Despite the impressive results, this type of treatment should be used very carefully, as often complications are noted - tissue atrophy, hyperpigmentation, the formation of telangiectasias and even ulcers.

Cryotherapy with liquid nitrogen. The surface of the rumen is treated with liquid nitrogen, as a result of which necrosis of the protruding part of the scar tissue develops. The surface is treated until the bubble appears, indicating a sufficiently deep impact. After the epithelization of the wound, the procedure is repeated.

This method gives good results in young keloid and hypertrophic scars, but it is less effective in old scars.

Laser therapy. The main advantage of a CO2 laser is minimal trauma to surrounding tissues. When using a laser, a minimal amount of necrotic tissue is formed, as a result of which a smaller scar is formed.

Injection of steroids. The most widespread recently received drugs such as triamcinolone (Kenalog-40) and hydrocortisone acetate suspensions.

Injections are carried out in courses of 3-5 sessions, between which make a break 7-10 days.

Before the introduction of the steroid, the soft tissues surrounding the scar are infiltrated with a 0.5% solution of lidocaine. Under the action of hormone therapy, the scar becomes soft, its volume is significantly reduced. However, in some cases, several months after completion of the treatment course, the growth of the keloid scar is resumed.

Application of silicone wafers. The first publications on silicone-gel plates appeared in the early 80's. In these studies, it was shown that the silicone coating itself (without pressing dressings) reduces the processes of excess scar formation.

Silicone-gel coating ("Epiderm") is a soft, sticky fabric coating made of hardened gel. It is absolutely non-toxic and does not irritate tissues.

The main requirement for the use of plates is to maintain the cleanliness of the surface of the plate and the area of the skin on which it is applied. The optimum period of the plate is 24 hours a day, the minimum period of application is 12 hours a day.

The plate is applied to the surface of the skin soaked with soap and washed so that it protrudes from the edges of the scar by 0.5 cm. Every 12 hours, the plate is removed, washed with a soap solution (as well as the scar area) and placed in place. After 10-14 days, the adhesive properties of the gel surface are lost. In this case, it is necessary to replace the plate with a new one. The duration of treatment is 2-3 months.

According to published data, relapses with this type of treatment were observed in 20-46% of cases.

In the Center for Plastic and Reconstructive Surgery, the silicone plates "Epiderm" were used to treat 30 patients with keloid scars. The time of application of the plates was 1.5-2 months. The accumulated experience allows us to state the following provisions:

• isolated application of silicone plates "Epiderm" for 1.5-2 months leads to a significant reduction in the volume of keloid and hypertrophic scar, but this effect is not stable, and the scar volume may increase again;
• silicone plates have a beneficial effect even on the scars of many years ago, but their therapeutic effect is more pronounced during the course of treatment in the period from 1 month and later from the date of surgery (during the final reorganization of the rumen);
• the use of silicone plates is possible only in cases where the scar is located in the anatomical zone, which has a flat non-curved surface that does not undergo deformation during movements.

[1], [2], [3], [4]