Hypertrophic Scar Formation and Treatment

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Questions and Answers

What is the primary characteristic of hypertrophic scar tissue?

Thin and transparent

Raised, red, and rigid (correct)

Elastic and flexible

Soft and pliable

What is the main reason for the excessive scar formation in hypertrophic scars?

Inflammation of the wound site

Underproduction of collagen

Overproduction of elastin

Overproduction of collagen or dermal content (correct)

Which of the following populations is more prone to hypertrophic scars?

Caucasians

Athletes

Dark-skinned population (correct)

Elderly individuals

What is the primary difference between normal skin and hypertrophic scar tissue in terms of collagen orientation?

Parallel collagen orientation in normal skin Signup and view all the answers

What is the main cause of functional and cosmetic problems in hypertrophic scars?

Multiple underlying dermal injuries Signup and view all the answers

What is the percentage of patients with deep second to third degree burns that are likely to develop hypertrophic scars?

More than 50% Signup and view all the answers

What is the primary characteristic that distinguishes keloids from hypertrophic scars?

Keloids exceed the boundaries of the original wound, while hypertrophic scars do not. Signup and view all the answers

What is the typical timeline for the development of keloids?

They occur within 4-5 weeks after injury. Signup and view all the answers

What is the primary factor that determines the likelihood of HTS formation?

Burn depth Signup and view all the answers

What is the primary difference in the dermal structure between keloids and hypertrophic scars?

Keloids have a highly vascularized dermis, while hypertrophic scars have a less vascularized dermis. Signup and view all the answers

What is the primary reason why keloids are more prevalent in certain areas of the body?

Because of the high skin tension in those areas. Signup and view all the answers

What is the typical time frame for hypertrophic scars to begin to appear?

Between 6 weeks to 3 months post-burn Signup and view all the answers

What is the purpose of inspecting a hypertrophic scar during management?

To determine the maturity of the scar. Signup and view all the answers

What is the characteristic of chronic HTS in terms of color?

Pale Signup and view all the answers

What is the main difference between HTS and keloid?

Orientation of collagen Signup and view all the answers

What is the significance of edema in a hypertrophic scar?

It is a sign of an immature scar. Signup and view all the answers

What is a common problem associated with hypertrophic scars?

Contracture formation Signup and view all the answers

How long does it typically take for a hypertrophic scar to fully mature?

1-2 years Signup and view all the answers

What is the method used to calculate the volume of a scar?

Syringe method Signup and view all the answers

What is the primary use of the Laser Doppler device?

To measure scar vascularity Signup and view all the answers

What is the purpose of using dental impression material?

To create a positive scar mold Signup and view all the answers

What is the advantage of using ultrasonography for scar assessment?

It is a non-invasive method Signup and view all the answers

What is a disadvantage of using the Laser Doppler device?

It is an expensive method Signup and view all the answers

What is one of the aspects of scar assessment that incorporates patient assessments?

All of the above Signup and view all the answers

What is the primary characteristic of a mature scar in terms of tissue regularity?

Regular Signup and view all the answers

What is the highest score possible in the Vancouver Scar Scale?

13 Signup and view all the answers

What is the primary advantage of the Modified Vancouver Scar Assessment Scale?

It is an abbreviated form of the Vancouver Scale Signup and view all the answers

What is the primary difference between the Patient Scar Assessment Scale and the Observer Scar Assessment Scale?

One is used for patients and the other for clinicians Signup and view all the answers

What is the characteristic of a scar with a score of 3 in the Pliability category of the Vancouver Scar Scale?

Firm Signup and view all the answers

What is the characteristic of a scar with a score of 2 in the Height category of the Vancouver Scar Scale?

Raised 2-5mm Signup and view all the answers

Study Notes

Definition and Incidence of Hypertrophic Scars

Hypertrophic scar (HTS) is a raised, red, rigid, and inflexible scar due to overproduction of collagen or dermal content within the wound boundaries.
HTS occurs in more than 50% of patients with deep second- to third-degree burns (dermis involved).
Higher incidence in children and dark-skinned population.
More prevalent in chest, neck, lower face burns, and near joints, where skin tension is greater.

Mechanism of Hypertrophic Scar Formation

Excessive deposition of fibroblast-derived extracellular matrix (ECM) proteins and especially collagen, over long periods, with persistent inflammation and fibrosis.

Characteristics of Hypertrophic Scars

Acute (immature) HTS: red, raised, and rigid.
Chronic (mature) HTS: pale, planner, and pliable.
Scar maturation: 4-8 weeks to full scar maturation with non-hypertrophic healing; hypertrophic scars begin to appear 6 weeks – 3 months post-burn and peak between 3-6 months post-burn.

Associated Problems with Hypertrophic Scars

Increased pain levels
Contracture formation
Loss of ROM
Elevated anxiety levels
Poor cosmoses
Decreased health-related quality of life

Differentiation between Hypertrophic Scars and Keloids

Hypertrophic scars: overproduction of collagen or dermal content within the boundaries of the wound.
Keloids: overproduction of collagen or dermal content exceeding the boundaries of the wound.
Keloids are more prevalent in chest, neck, lower face burns, and near joints, where skin tension is greater.

Assessment Tools for Hypertrophic Scars

Inspection: color, height, edema, and site of injury.
Palpation: temperature, height, and regularity of tissue.
Vancouver Scar Assessment Scale: evaluates vascularity, pigmentation, pliability, and height.
Modified Vancouver Scar Assessment Scale: abbreviated form of Vancouver scale, includes vascularity, pliability, and height.
Patient and Observer Scar Assessment Scale (POSAS): measures scar quality from patient and clinician perspectives, includes subjective symptoms of pain and pruritus.
Objective Assessment:
- Scar Volume: using dental impression material and syringe method.
- Vascularity of scar: using Laser Doppler device.
- Thickness of scar: using ultrasonography.

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Description

This quiz covers the definition, causes, and mechanism of hypertrophic scar formation, as well as its assessment and treatment approaches. It also differentiates hypertrophic scars from keloids and designs a treatment program.