Evaluation of Triamcinolone Injection and Subcision as a First-Line Non-Surgical Treatment of Post-Traumatic Acute Trap-Door Deformity

Abstract

Background Trap-door deformity is a biophysical phenomenon in which U-, C-, or Vshaped linear scars tend to become depressed and the tissue circumscribed by them tends to bulge. The aim of the present study was to demonstrate the efficacy of triamcinolone acetonide (TCA) injection and subcision as a first-line treatment for post-traumatic acute trap-door deformity. Methods In trap-door deformity patients, a subcision was made by cutting the fibrotic band along the scar line in the depression using a 22-gauge needle. TCA was administered. An intralesional injection was made along areas of scarring that were difficult to penetrate with the needle. Scar quality parameters were assessed at each follow-up by a single observer and the patient, using the patient and observer scar assessment scale (POSAS) with an additional question about bulging. Results The average POSAS score per question on the observer scale improved from 6.6±1.31 to 3.6±1.08, and the average POSAS score per question on the patient scale improved from 5.5±1.57 to 2.5±1.26. The average bulging score on the observer scale decreased from 6.0±0.98 to 3.0±0.83, and that on the patient scale decreased from 5.0±1.67 to 2.0±1.30. The average general opinion score on the observer scale decreased from 5.5±1.12 to 3.5±0.91, and that on the patient scale decreased from 6.0±1.84 to 2.0±0.79. Conclusions Better outcomes can be obtained by using both TCA and subcision as the first-line therapy for post-traumatic acute trap-door deformity.

Successful Treatment of Infraorbital Trapdoor Following Transposition Flap Using Intralesional Corticosteroid: A Case Report

“…A similar good result was reported in a South Korean study. 4 However, their method was slightly different to ours, as they performed a subcision of the bulge before injecting the TCA, and added 2% lidocaine to the TCA to reduce pain.…”

“…However, the most accepted etiology is the retraction of a U-, C-, or V-shaped curved scar. 4 The formation of the trapdoor effect has been reported to occur as early as 3 weeks postoperatively and as late as 6 to 8 months postoperatively. 5 Intralesional corticosteroids have long been used to treat various dermatological conditions.…”

“…We used TCA because it is the most well-known and most commonly used intralesional corticosteroid. 4,7 Although some previous studies have reported that surgical treatment of the trapdoor effect produces a better outcome than a nonsurgical approach, 3 we chose to use intralesional cortico-steroids in accordance with the patient's preference for non-invasive treatment. Injecting into the infraorbital region can be challenging due to the proximity to the eye.…”

“…The exact pathophysiology of the trapdoor effect is unknown. However, the most accepted etiology is the retraction of a U-, C-, or V-shaped curved scar 4 . The formation of the trapdoor effect has been reported to occur as early as 3 weeks postoperatively and as late as 6 to 8 months postoperatively 5 …”

“…One non-surgical approach to treat the trapdoor effect is the intralesional injection of corticosteroids, but there is limited information available about the effectiveness of this approach. [3][4] Herein, we report a case in which a 60-year-old woman with the trapdoor effect in the right infraorbital region after Mohs micrographic surgery and transposition flap surgery was successfully treated with long-term intralesional corticosteroid injections, to provide evidence for treatment for the trapdoor effect.…”