Papers of The 8th Japan Scar Workshop

1. Surgical Treatment for Keloids and Hypertrophic Scars
~Our Approach and Recent Experiences~

Keisuke Okabe, Noriko Aramaki, Kazuo Kishi
Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, Japan

Keloids and hypertrophic scars are treated by either radical surgical resection or non-surgical conservative therapies including steroid injection and/or patch, laser treatment, cryotherapy, and compression. The advantages of surgical resection are that we can remove the lesion completely, and keloids accompanying scar contracture or infectious cysts can be removed by surgery only. However, recurrence after surgery may always occur, and the recurrent lesion can be larger than the original one. There are other problems of how to treat recurrent lesions and the possibility of developing secondary malignancy after surgery and irradiation. On the other hand, conservative therapy is safe, easy, and there is seldom any risk of enlargement. In particular, the combination of local steroid injection and patch therapy is usually effective, and the pain accompanying injection can be controlled by local anesthetic injection into the surrounding subcutaneous tissue. The disadvantages are that the effectiveness of conservative therapy is unpredictable and the duration of therapy can be long. We think that surgical therapy should be indicated for keloids where the lesions (1) are small or narrow enough to be excised by simple resection, (2) accompany scar contractures, or (3) infectious cysts.
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