title: Extramarginal excision is preferable for hypertrophic scars.
abstract: BACKGROUND
  Recently, higher proliferative activity and collagen production in the peripheral parts of keloids have been reported. Therefore, we hypothesized that insufficient removal of active proliferating and collagen-producing fibroblasts at the scar margin might cause a high recurrence rate of hypertrophic scars and keloids. To address this hypothesis, we evaluated the influence of surgical margins on the recurrence of hypertrophic scars and compared the recurrence rates between intramarginal excision and extramarginal excision.
  
  
  METHODS
  A retrospective review was performed of patients with car tire injury-induced hypertrophic scars treated by surgical excision from 2004 to 2010. To evaluate the influence of surgical margins on the recurrence of hypertrophic scars, we divided these patients into two groups, the intramarginal excision group and the extramarginal excision group, and compared the recurrence rate.
  
  
  RESULTS
  A total of 15 patients with car tire injury-induced hypertrophic scars were treated with surgical excision and skin grafting. The recurrence rate in those with intramarginal excision was significantly higher than in those with extramarginal excision. All patients treated with intramarginal excision experienced hypertrophic scar recurrence within six months. Three of nine patients exhibited recurrence when the hypertrophic scars were excised with a 3-5 mm margin.
  
  
  CONCLUSIONS
  Extramarginal excision with complete removal of the abnormal collagen bundles followed by skin grafting is a viable alternative to reconstruction of the foot after hypertrophic scar excision, and this treatment can effectively decrease issues related to recurrence.
authors.affiliation: Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jung U
authors.initials: JU
authors.lastname: Shin
authors.forename: Jihun
authors.initials: J
authors.lastname: Park
authors.forename: Ju Hee
authors.initials: JH
authors.lastname: Lee
authors.forename: Kwnag Hoon
authors.initials: KH
authors.lastname: Lee
authors.forename: Yong-Ook
authors.initials: YO
authors.lastname: Kim
authors.forename: Chae-Ok
authors.initials: CO
authors.lastname: Yun
authors.forename: Won Jai
authors.initials: WJ
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D016512:Ankle Injuries / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D017439:Cicatrix, Hypertrophic / Q000601:surgery*; D062109:Dermatologic Surgical Procedures / Q000379:methods*; D005260:Female; D018409:Foot Injuries / Q000601:surgery; D058752:Free Tissue Flaps; D006801:Humans; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D017768:Skin, Artificial