Scar management: prevention and treatment strategies.
OBJECTIVE
Aberrant wound healing results in unsightly scar, hypertrophic scar, and keloid formation, causing functional and cosmetic deformities, discomfort, psychological stress, and patient dissatisfaction. Scar prevention and management, both surgical and nonsurgical, continue to be important issues for the otolaryngologist.


RESULTS
Both animal and human models continue to point to the integral role of transforming growth factor-beta in aberrant healing. Multiple extracts have promising results as therapies for scarring and are widely marketed but need to be further investigated. Scar prevention advancements include refinements in surgical technique, nutritional supplementation, and optimal wound care. Steroid injections continue to play a major role in the regression of scars and keloids. Dermatography assists in the minimization of scar appearance. Dermatography, laser therapies, intralesional 5-fluorouracil, and adjuvant radiotherapy are emerging therapies. Topical vitamin E utility is revisited. New surgical scar revision techniques include modified excision techniques and skin grafting.


CONCLUSIONS
Despite optimal efforts to avoid scar formation, aberrant wound healing may occur. The use of topical agents and intralesional steroid injections can minimize early scar formation. Strategies for prevention and management of keloids and hypertrophic scars continue to develop, as the basic science mechanisms underlying aberrant wound healing are elucidated.
Chen
Margaret A
MA
Department of Surgery, Division of Head and Neck Surgery, School of Medicine, University of California-San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.
Davidson
Terence M
TM
D017439:Cicatrix, Hypertrophic / Q000517:prevention & control* / Q000628:therapy*; D017679:Cryotherapy; D006801:Humans; D007627:Keloid / Q000517:prevention & control* / Q000628:therapy*; D053685:Laser Therapy; D009779:Occlusive Dressings; D011878:Radiotherapy; D016038:Skin Transplantation; D016212:Transforming Growth Factor beta / Q000627:therapeutic use; D014945:Wound Healing / Q000502:physiology*
D016212:Transforming Growth Factor beta