‫بسم هللا الرحمن الرحيم‬

‫وقل رب زدنى علما‬

SCAR
AND

KELIOD
 Dr. Imrana Aziz
Assistant Professor
Surgical Deptartment
 Wound Healing
 I. Inflammatory Phase (Immediate to 2-5 days)
A) Hemostasis
 Vasoconstriction
 Platelet aggregation
B) Inflammation
 Vasodilation
 Phagocytosis
 II. Proliferative Phase (2 days to 3 weeks)
A) Granulation
 Fibroblasts produce collagen
 Fills defect and produces new capillaries

B) Contraction

C) Epithelialization
 III. Remodeling Phase (3 weeks to 2 years)

 A) Increases tensile strength to wounds

 B) Organised, flatteed scar produce

 1-6 weeks 2 wks- 2yrs 6mths-2yrs
Healing Remodeling Maturation
 Exudate Red Pale
Scab Raised Flat
Fine line Itchy Quiet
Tender contractive
contraction
 Scars (Cicatrix)

 A scar is a permanent patch of skin that

grows over a wound. (after a cut, scrape,
burn or sore, surgery cuts, infections, skin
conditions like acne).
 Factor for ideal scar:
 Intrinsic:
 Age: old person
 Chronic disease
 Abnormal collagen syndrom: ehlers –
danlos
 Malnutrition
 Smoking
 Obesity
 Extrinsic:

 Achieve quiet primary healing

 Clean incised edges,no tissue losS

 Avoid dehiscence or infection

 Minimise tension
 Factor for ideal scar

 Align scar with wrinkle, injection or

relaxed skin tension line

 Site: eyelids, genitalia, palm vermilion

 Fine lax skin

Importance of line of langer`s:
 These are tension lines, due to the
patterens of arrangement of collegen fiber
in dermis.
 Skin creases, wrinkles of ageing parallel
with tension lines.
 Incisions made along skin tension lines
heal with minimum scarring.
 Types of Scar
 Normal scar
 Widened scar
 Atrophic scar
 Hypertrophic scar
 Keliod scar
 Normal scar:
 Forms after 2-3 wks.
 Appear flatten to a linear white line.

Widened scar:
 occurs in sites of higher.

 Atrophic scar:
 Acne vulgaris, varcella infection ,
immunization sites leave atrophic scar
 Hypertrophic Scar

 These are overgrowth of fibrous scar

tissue that remains within boundaries of
original wound and tend to regress
spontaneously
 Keliod:

 scar in which there is overgrowth of dense

fibrous tissue beyond the wound limit.
They do not regress spontanously.
 Aetiology
 The cause is unknown
 these scars seem to function
autonomously resulating in an increase in
the production of fibroblastic collagen and
metaloproteinase and dec: in collagen
degradation
 Epidemiology
 common in people with darker skins,
especially African-American races.

 The peak age is 10-30 years,

 keloids are less common at the extremes
of age.

 There may be a family history of tendency

to develop keloids
 Presentation:

Symptoms
 Cosmetic
 Tender
 Painful
 Itch
 Burning sensation.

 History of trauma :accidental, surgical or

cosmetic, Burn scars or infected lesions,
including acne, are more likely to form keloids.
 Clinical features:
 Sites : the most common areas are sternum,
shoulder, earlobe and cheek
 Raised and irregular
 Beyond the original line of trauma.
 rubbery texture.
 It is red in the early stages, but becomes brown
or pale with age.
 No hair follicles or sweat glands within the scar.
 Keloids over a joint can contract and restrict
movement.
 Clinical course: The natural history is variable:
 It is red in the early stages, but becomes
brown or pale with age.
 No hair follicles or sweat glands within the
scar.
 Keloids over a joint can contract and
restrict movement.
 Clinical course: The natural history is
variable:
 Comparison of hypertophic and
keliod
feature Hypertrophic scar Keliod scar
Genetic Not familial May be familial
Race Not related Black > white
Sex F=M F>M
Age Children 10-30 yrs
borders Remains whithin Outgrows wound
wound area
feature HYPERTROPHIC KELIOD
Natural Subsides with Rarely subsides
history time
Site Flexor surface Sternum, shoulder,
face
Etiology Related to tension Unknown
Related to poor
surgical
Affect of technique.
prgnancy Not affacted Inc: risk in
pregnancy and
puberty
Hypertrophic Keliod
Some immunological Not related to
abnormalities immunological
abnormalities
Electron microscope Electron microscope
shows thin organized shows thick,
collagen bundles. disorganized collagen.
 Management:
 There is no universal treatment for
abnormal scar.

 Medical treatment:
 pressure dressing
 compressive dressing
 silicone gel pad.
 cortisone injections

 Radiotherapy

 Cryotherapy

 Laser treatment
 interpheron

 Cytotaxic drugs

 Other therapies
 vit:E
 allantion
Surgical treament
Z plasty
Y-V advancement flap

Intensive Physiotherapy
 Therapeutic scaring

Many societies done the scarification

as sign of beauty or decoration.