Scar Revision Review Thomas JR Somenek M Scar

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Scar Revision Review Thomas JR, Somenek M. Scar revision review. Arch Facial Plast Surg.

Scar Revision Review Thomas JR, Somenek M. Scar revision review. Arch Facial Plast Surg. 2012; 14(3): 162 -174. Copyright restrictions may apply

Introduction • Numerous surgical and nonsurgical therapies have been developed over the years to

Introduction • Numerous surgical and nonsurgical therapies have been developed over the years to revise facial scars. • When deciding on whether to use surgical vs nonsurgical therapy, the characteristics of the scar need to be assessed. These include the position, location, age of the scar, and skin type of the patient. • The ultimate goal is to modify the scar to a point of maximal camouflage within the junction of facial landmarks, natural facial contour lines, and borders that exist within the head and neck. Copyright restrictions may apply

Purpose • The purpose of the study is to perform a comprehensive review of

Purpose • The purpose of the study is to perform a comprehensive review of nonsurgical and surgical modalities used in the management of scars. Copyright restrictions may apply

Relevance to Clinical Practice • When a scar involves the face, one of the

Relevance to Clinical Practice • When a scar involves the face, one of the most prominent parts of the body, it can have significant implications for the patient. These can include psychological as well as social consequences, leading to a diminished quality of life. • Factors that the surgeon can control include the favorable repositioning of the scar, proper alignment of the wound edges, and meticulous handling of the tissues. • Nonsurgical therapies also play a role in the management of scars and should be included in the treatment regimen. Copyright restrictions may apply

Description of Evidence • Articles were identified in standard Pub. Med searches using keywords

Description of Evidence • Articles were identified in standard Pub. Med searches using keywords appropriate for each underlined category. • These articles included the following: – Review articles. – Clinical trials. – Meta-analyses. – Case studies. – Cohort studies. Copyright restrictions may apply

Description of Evidence A B Figure 1. An earlobe keloid scar from ear piercing

Description of Evidence A B Figure 1. An earlobe keloid scar from ear piercing (A), and the earlobe following excision, serial steroid injections, and local pressure to the site (B). Copyright restrictions may apply

Description of Evidence A B Figure 2. A widened forehead scar (A), and intraoperative

Description of Evidence A B Figure 2. A widened forehead scar (A), and intraoperative excision and closure with running W-plasty (B). Copyright restrictions may apply

Description of Evidence C D Figure 2. Preoperative appearance (C), and final appearance 6

Description of Evidence C D Figure 2. Preoperative appearance (C), and final appearance 6 months following W-plasty and dermabrasion (D). Copyright restrictions may apply

Controversies and Consensus • Corticosteroids are a relatively safe and effective therapy frequently used

Controversies and Consensus • Corticosteroids are a relatively safe and effective therapy frequently used as first-line therapy in conjunction with surgical excision in the treatment of hypertrophic scars and keloids. • Intralesional fluorouracil has been shown to be effective as a monotherapy, but it may have a greater impact when used in polytherapy as evidenced by success in the aforementioned studies. • The role of imiquimod in the treatment of hypertrophic scars needs further evaluation in a large-scale setting. • Radiation therapy has been shown to be inadequate as a monotherapy. For this reason, it is frequently combined with surgical resection. – Treatment schedule and follow-up doses vary considerably among the studies. – Despite there being a low risk of complications such as radiation-induced malignancies, this modality should be reserved for scars that are unresponsive to other treatments. Copyright restrictions may apply

Controversies and Consensus • Bleomycin therapy requires further investigation with larger prospective studies as

Controversies and Consensus • Bleomycin therapy requires further investigation with larger prospective studies as it has shown promising results among smaller cohorts of patients. • Pressure therapy can play a role in the treatment of hypertrophic scars; however, more definitive research needs to be undertaken to evaluate optimal treatment parameters. • There a multitude of techniques that can be used when attempting to surgically revise a scar, and the optimal treatment parameters need to be evaluated prior to excision to achieve the best cosmetic outcome. Copyright restrictions may apply

Discussion: Emerging Therapies and Future Implications • Transforming growth factor-β has shown promise in

Discussion: Emerging Therapies and Future Implications • Transforming growth factor-β has shown promise in several prospective clinical trials as an emerging treatment for scars. – This has potential to play a larger role in the treatment of scars. • Angiotensin-converting enzyme is present in tissues composed largely of fibrillar collagen. Angiotensin-converting enzyme inhibitors have been shown in smaller-scale studies to provide marked improvement in the cosmetic outcome of keloids. – This is a preliminary observation that needs to be validated by a larger randomized controlled study. • Prostaglandins have been shown to induce fibroblast proliferation and collagen deposition in the animal model. – Cyclooxygenase-2 inhibitors have been postulated to alter keratinocyte proliferation. – Despite some promising results, there is conflicting evidence when looking at the effect of cyclooxygenase-2 inhibitors on wound healing. Copyright restrictions may apply

Conclusions • A number of therapeutic strategies have been developed in an attempt to

Conclusions • A number of therapeutic strategies have been developed in an attempt to reduce and prevent scars. Despite this, there remains no universal consensus regarding the optimal treatment strategy. • The goal of scar revision is not to erase scars, but to make them better. Sometimes despite one’s best efforts, an optimal outcome may not occur. • Analyzing the characteristics of the scar is one of the keys to determine how to make the scar less noticeable. • Using the aforementioned techniques can provide the surgeon with the complete armamentarium necessary to positively influence each and every patient. Copyright restrictions may apply

Contact Information • If you have questions, please contact the corresponding author: – J.

Contact Information • If you have questions, please contact the corresponding author: – J. Regan Thomas, MD, Department of Otolaryngology–Head and Neck Surgery, University of Illinois at Chicago, 1855 W Taylor St, MC 648, Chicago, IL 60612 (thomasrj@uic. edu). Copyright restrictions may apply