[Early hypertrophic scar after surgery on the nasal region: value of long-acting corticosteroid injections].
BACKGROUND
"Pincushioning" is a complication of post-surgical scarring following use of transposition flaps particularly when surgery is performed on the nasal region. The transposition flap technique is very useful for the repair of certain defects of the tip of the nose, the medial canthus or of the ala nasi. The aim of this study is to define the clinical characteristics of this scarring dystrophy, which we propose to call "early hypertrophy scarring", to clarify the nature thereof and to assess the efficacy of intralesional injection of corticosteroids at the first signs of hypertrophy.


METHODS
A prospective, open, non-comparative, single-centre study examined the clinical and histological characteristics of early hypertrophy scarring and the effectiveness of therapy with one or two injections of corticosteroids performed on the 15th day post-operatively and optionally repeated at D45 depending on the outcome. From January 2011 to January 2013, 12 consecutive patients with early hypertrophy scarring were included (ten men and two women - mean age: 64 years). All had undergone surgery for basal cell carcinoma under local anaesthesia with one-stage repair by means of a rhombic flap or a bilobed flap located in the nasal area. Scars were injected strictly intra-lesionally with triamcinolone acetate (40 mg/1 mL) until whitening occurred. A single injection was performed in three cases of rhombic flap while a second injection was given at D45 in the remaining nine cases.


RESULTS
Complete regression of the early hypertrophy scarring was obtained in ten of the 12 patients by D90. Incomplete regression was observed but with a marked improvement in the other two patients.


CONCLUSIONS
Early hypertrophy scarring is distinguished by its clinical characteristics of hypertrophic or keloid scars. Biopsy performed in two cases showed the fibrous but non-fatty nature of early hypertrophy scarring. Biomechanical factors particular to the nasal region and the transposition flap technique could account for the early and excessive collagen production causing early hypertrophy scarring. Early injection of corticosteroids, which was consistently effective in our study, could represent a simple treatment for early hypertrophy scarring, thus avoiding surgical correction. These preliminary results in a small number of patients require confirmation by a comparative, multicentre, prospective controlled study.
Service de dermatologie, hôpital Saint-André, 1, rue Jean-Burguet, 33000 Bordeaux, France. Electronic address: jmamici@numericable.fr.
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Amici
D000368:Aged; D002280:Basal Cell Carcinoma / Q000601:surgery; D017439:Cicatrix, Hypertrophic / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D003094:Collagen / Q000032:analysis; D003692:Delayed-Action Preparations; D005260:Female; D005355:Fibrosis; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D009666:Nose / Q000601:surgery*; D009669:Nose Neoplasms / Q000601:surgery; D011183:Postoperative Complications / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D011446:Prospective Studies; D012878:Skin Neoplasms / Q000601:surgery; D013524:Surgical Flaps / Q000009:adverse effects*; D014221:Triamcinolone / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D014945:Wound Healing
D003692:Delayed-Action Preparations; D014221:Triamcinolone; D003094:Collagen
Chirurgie dermatologique; Cicatrice hypertrophique; Cicatrisation; Complication; Corticosteroid injection; Dermatological surgery; Injection intralésionnelle de corticoïde; Lambeau de transposition; Pincushioning; Scarring; Transposition flap; Trap-door deformity; Wound healing