A Comparison of Intramarginal and Extramarginal Excision of Hypertrophic Burn Scars

Engrav, Loren H.; Gottlieb, Jourdan R.; Millard, Steven P.; Walkinshaw, Marcus D.; Heimbach, David M.; Marvin, Janet A.

doi:10.1097/00006534-198801000-00007

Cited by 44 publications

(22 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…73,95 Subtotal (intramarginal) excisions with lateral undermining, where a rim of keloid tissue is left behind, has been shown to reduce recurrence rates because of decreased collagen synthesis and reduced wound tension. 134, 187 Skin grafts have a recurrence rate of 59%, and half of the patients develop keloids at the donor site. 20, 188 During surgery, sources of residual inflammation that stimulate fibrogenic growth factors must be removed.…”

Section: Surgerymentioning

confidence: 99%

Prevention and Management of Hypertrophic Scars and Keloids After Burns in Children

Berman

Viera

Amini

et al. 2008

Journal of Craniofacial Surgery

130

View full text Add to dashboard Cite

Hypertrophic scars and keloids are challenging to manage, particularly as sequelae of burns in children in whom the psychologic burden and skin characteristics differ substantially from adults. Prevention of hypertrophic scars and keloids after burns is currently the best strategy in their management to avoid permanent functional and aesthetical alterations. Several actions can be taken to prevent their occurrence, including parental and children education regarding handling sources of fire and flammable materials, among others. Combination of therapies is the mainstay of current burn scar management, including surgical reconstruction, pressure therapy, silicon gels and sheets, and temporary garments. Other adjuvant therapies such as topical imiquimod, tacrolimus, and retinoids, as well as intralesional corticosteroids, 5-fluorouracil, interferons, and bleomycin, have been used with relative success. Cryosurgery and lasers have also been reported as alternatives. Newer treatments aimed at molecular targets such as cytokines, growth factors, and gene therapy, currently in developing stages, are considered the future of the treatment of postburn hypertrophic scars and keloids in children.

show abstract

Section: Surgerymentioning

confidence: 99%

Prevention and Management of Hypertrophic Scars and Keloids After Burns in Children

Berman

Viera

Amini

et al. 2008

Journal of Craniofacial Surgery

130

View full text Add to dashboard Cite

show abstract

“…This regimen is unavoidable in large keloids 30 , 31 (Figure 2). Intramarginal excision is advisable because it is followed by a lower recurrence rate when compared to extramarginal excision 32 . Removal of the lesion by surgery or CO 2 laser presents similar recurrence rates; 33 however, CO 2 laser provides a high degree of hemostasis and avoidance of sutures.…”

Section: Cryosurgery In the Treatment Of Keloids And Hypertrophic Scarsmentioning

confidence: 99%

Current developments and uses of cryosurgery in the treatment of keloids and hypertrophic scars

Zouboulis

Zouridaki

Rosenberger

et al. 2002

Wound Repair Regeneration

View full text Add to dashboard Cite

Cryosurgery is currently regarded as the treatment of choice for keloids and hypertrophic scars. Four techniques are established or currently under evaluation in this area. The first is cryosurgery as monotherapy. Using this regimen, 241 of 356 patients (68%) with keloids and 72 of 89 patients with hypertrophic scars (81%), showed a greater than 50% improvement or complete regression (five studies). Using the second technique, cryosurgery with intralesional corticosteroids, significant regression of keloids was found in 119 of 159 patients (75%; four studies). Cryosurgery induces tissue edema and facilitates intralesional injections; however, the combined therapy was not superior (90% greater than 50% reduction of lesional volume) to monotherapy (83.3%) in a study of 40 patients with keloids. The third technique is surgical debulkment prior to cryosurgery without corticosteroids. This regimen is unavoidable in large keloids; however, it can result in recurrences despite its shortterm promising effects. Intralesional cryosurgery, the fourth technique, was developed by modifying the technique by Weshahy and is under evaluation in our department. In addition, histological and immunohistological studies of keloids and keloidal fibroblasts in vitro treated by cryosurgery have detected changes indicating potential rejuvenation of the scars.

show abstract

“…72 Subtotal excisions, where a rim of keloid is left behind, has been advocated to result in a better outcome because of low wound tension and decreased collagen synthesis. 73 Small hypertrophic scars may successfully be managed by the scar reorientating and tension-releasing Z-and W-plasties, but the use of nonsurgical adjuvant therapy is recommended. 74 It should be highlighted that the evidence base for the surgical strategies outlined above is overall inadequate and caution is advised before adopting them in clinical practice.…”

Section: Surgery Lasers and Radiation Key Pointsmentioning

confidence: 99%

Cutaneous scarring: Pathophysiology, molecular mechanisms, and scar reduction therapeutics

Tziotzios

Profyris

Sterling

2012

Journal of the American Academy of Dermatology

159

115

View full text Add to dashboard Cite

A Comparison of Intramarginal and Extramarginal Excision of Hypertrophic Burn Scars

Cited by 44 publications

References 0 publications

Prevention and Management of Hypertrophic Scars and Keloids After Burns in Children

Prevention and Management of Hypertrophic Scars and Keloids After Burns in Children

Current developments and uses of cryosurgery in the treatment of keloids and hypertrophic scars

Cutaneous scarring: Pathophysiology, molecular mechanisms, and scar reduction therapeutics

Contact Info

Product

Resources

About