[libribook.com] Traumatic Scar Tissue Management 1st Edition

Table 6.1
Comparison of scars (Ogawa 2008, Bordoni & Zanier 2013, Bordoni & Zanier 2013, Zhu et al.
2013, Rabello et al. 2014)
Hypertrophic scarring can result in disfigurement and scarring that affects
quality of life which, in turn, can lead to lowered self-esteem, social isolation,
prejudicial societal reactions and job discrimination. Scarring also has profound
rehabilitation consequences, including loss of function, impairment, disability,
and difficulties pursuing recreational and vocational pursuits (Engrav et al.
2007).
Bacterial colonization and wound infection tend to promote the formation of
hypertrophic scars (Niessen et al. 2004, Chan et al. 2005, Baker et al. 2007,
Berman et al. 2007, Cho et al. 2014). Hypertrophic scarring usually develops
within 1–3 months following wound infection, wound closure with excess
tension or other traumatic skin injury (Brissett & Sherris 2001, Cho et al. 2014).
Hypertrophic scarring exhibits a rapid growth phase for up to 6 months, and then
gradually regresses over a period of a few years.
Keloids seem to be a more sustained and aggressive fibrotic disorder than
hypertrophic scars (Brown & Bayat 2009). Research to date strongly suggests a
more prolonged inflammatory period, with immune cell infiltrate present with
keloids (Slemp & Kirschner 2006).
Precise etiologic factors associated with keloid formation are elusive. Keloids
may develop anywhere from a year up to several years after minor injuries and
may even form spontaneously on the mid-chest in the absence of any known
injury (Brissett & Sherris 2001, Cho et al. 2014). Keloids are persistent and do
not regress spontaneously.
Keloids appear as firm, mildly tender, bosselated (small knob-like projections)
tumors with a shiny surface and sometimes telangiectasia (small, widened blood
vessels on the skin which are usually meaningless, but may be associated with
several diseases) (NIH 2015). The epithelium is thinned and there may be focal
areas of ulceration.