Objectives: We present a new classification pathological scars based on their width, extension, placement to relaxed skin tension lines, affectation of critical zones, texture, flexibility, hardness, retraction, level with the surrounding tissue, color match with surrounding tissue and quality; that helps in the decision of the treatment methods to improve its appearance based on our experience in the Department of Maxillofacial and Plastic Surgery of the Salam Clinic (Tangier).
Introduction: Scars are a natural consequence of all dermal healing following surgical incisions, lacerations, or tissue loss.
When the scar has unfavorable characteristics, scar revision is often indicated to improve aesthetics, reduced recurrence, and/or correct functional limitations.
We have many treatment options (Cortico steroids, peeling, dermabrasion, silicone patches, subincision, PRP...) and the cosmetic surgeon must be knowledgeable of different techniques (minimally invasive vs surgical) to obtain the best results.
There are different evaluation methods (Vancouver, POSAS——) but are deficients.
Materials / method: The first step is to evaluate and treat critical factors like:
-Width.
-Extension.
-Placement to relaxed skin tension lines.
-Affectation of critical zones.
In the second step we have to evaluate and treat the hardness of the scar: we distinguish four factors (texture, flexibility, hardness and retraction):
1-Texture: we can find three types of scars
1.1-Smooth.
1.2-Fibrous band.
1.3 Surface fibrous folds.
2-Flexibility: we do 2 tests
2.1-Proof of Extension and Flexibility
2.2-Yielding to acupressure
3-Hardness (soft, hard, very hard)
4-Retraction
Results: Finally the third step is to evaluate and treat scar level, color and quality:
1-Level with the surrounding tissue: 3 options
1.1-Flat
1.2-Stepped: the edges can be soft or hard
1.3-Raised: can be
1.3.1-Hypertrophic
1.3.2-Keloid: if pediculated evaluate excision + humid cure +/- infiltrate CC
2-Color match with surrounding tissue
2.1-Yes
2.2-No:
2.2.1-White and visible?
2.2.2-Post-inflammatory hyperpigmentation?
2.2.3-Flat + hyper or hypo-pigmented.
2.2.4-Is it pink/red?
2.2.4.1-If keloid / hypertrophic: infitrate CC + peeling
2.2.4.2-If it is flat: is it red?
Conclusion: This new classification of pathological scar helps in the decision making of the scar treatment.
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