Postoperative Scar Management Protocol for Asian Patients.
Asian
Botulinum toxin
Cosmetic
Intralesional steroid
Keloid
Scar protocol
Journal
Aesthetic plastic surgery
ISSN: 1432-5241
Titre abrégé: Aesthetic Plast Surg
Pays: United States
ID NLM: 7701756
Informations de publication
Date de publication:
09 Nov 2023
09 Nov 2023
Historique:
received:
24
07
2023
accepted:
12
09
2023
medline:
9
11
2023
pubmed:
9
11
2023
entrez:
9
11
2023
Statut:
aheadofprint
Résumé
Postoperative scar formation remains a morbidity for patients even with the advent of minimally invasive techniques. Furthermore, the significant difference between the Asian and Caucasian skin results in poorer postoperative scar outcomes in Asians, supporting the need for an evidence-based scar management protocol. Following a literature review of the PubMed and the Cochrane databases over the past 10 years, we constructed a novel postoperative scar management protocol for the Asian skin, utilized in a Singaporean tertiary healthcare institution. We describe a timeline-based scar protocol from the point of skin closure to a minimum of 1 year of follow-up. We support the use of intraoperative botulinum toxin for selected high-risk individuals upon skin closure with a follow-up regimen in the postoperative setting. For recalcitrant keloids, we have described a multimodal therapy comprising elements of intralesional steroids, botulinum toxin, lasers, surgery, and radiotherapy. A consolidated postoperative scar management protocol provides the necessary guidance for improved scar outcomes in the Asian skin. There is inherent potential in expanding the protocol to include post-traumatic and burn wounds or support other skin types including the Caucasian skin. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Sections du résumé
BACKGROUND
BACKGROUND
Postoperative scar formation remains a morbidity for patients even with the advent of minimally invasive techniques. Furthermore, the significant difference between the Asian and Caucasian skin results in poorer postoperative scar outcomes in Asians, supporting the need for an evidence-based scar management protocol.
METHODS
METHODS
Following a literature review of the PubMed and the Cochrane databases over the past 10 years, we constructed a novel postoperative scar management protocol for the Asian skin, utilized in a Singaporean tertiary healthcare institution.
RESULTS
RESULTS
We describe a timeline-based scar protocol from the point of skin closure to a minimum of 1 year of follow-up. We support the use of intraoperative botulinum toxin for selected high-risk individuals upon skin closure with a follow-up regimen in the postoperative setting. For recalcitrant keloids, we have described a multimodal therapy comprising elements of intralesional steroids, botulinum toxin, lasers, surgery, and radiotherapy.
CONCLUSIONS
CONCLUSIONS
A consolidated postoperative scar management protocol provides the necessary guidance for improved scar outcomes in the Asian skin. There is inherent potential in expanding the protocol to include post-traumatic and burn wounds or support other skin types including the Caucasian skin.
NO LEVEL ASSIGNED
METHODS
This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Identifiants
pubmed: 37943348
doi: 10.1007/s00266-023-03696-2
pii: 10.1007/s00266-023-03696-2
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.
Références
Soltani AM, Francis CS, Motamed A, Karatsonyi AL, Hammoudeh JA, Sanchez-Lara PA et al (2012) Hypertrophic scarring in cleft lip repair: a comparison of incidence among ethnic groups. Clin Epidemiol 4:187–191
pubmed: 22879780
pmcid: 3413167
Ogawa R, Dohi T, Tosa M, Aoki M, Akaishi S (2021) The latest strategy for keloid and hypertrophic scar prevention and treatment: the nippon medical school (NMS) protocol. J Nippon Med Sch 88(1):2–9
pubmed: 32741903
doi: 10.1272/jnms.JNMS.2021_88-106
Lv K, Xia Z (2018) Chinese expert consensus on clinical prevention and treatment of scar. Burns Trauma 6:27
pubmed: 30263894
pmcid: 6154406
doi: 10.1186/s41038-018-0129-9
Potter DA, Veitch D, Johnston GA (2019) Scarring and wound healing. Br J Hosp Med Lond 80(11):C166–C171
pubmed: 31707882
doi: 10.12968/hmed.2019.80.11.C166
Dohi T, Padmanabhan J, Akaishi S, Than PA, Terashima M, Matsumoto NN et al (2019) The interplay of mechanical stress, strain, and stiffness at the keloid periphery correlates with increased caveolin-1/ROCK signaling and scar progression. Plast Reconstr Surg 144(1):58e–67e
pubmed: 31246819
doi: 10.1097/PRS.0000000000005717
Quong WL, Kozai Y, Ogawa R (2017) A case of keloids complicated by castleman’s disease: interleukin-6 as a keloid risk factor. Plast Reconstr Surg Glob Open 5(5):e1336
pubmed: 28607862
pmcid: 5459645
doi: 10.1097/GOX.0000000000001336
van der Veer WM, Bloemen MC, Ulrich MM, Molema G, van Zuijlen PP, Middelkoop E et al (2009) Potential cellular and molecular causes of hypertrophic scar formation. Burns 35(1):15–29
pubmed: 18952381
doi: 10.1016/j.burns.2008.06.020
Ogawa R (2017) Keloid and hypertrophic scars are the result of chronic inflammation in the reticular dermis. Int J Mol Sci 18(3):526489
doi: 10.3390/ijms18030606
Ogawa R, Okai K, Tokumura F, Mori K, Ohmori Y, Huang C et al (2012) The relationship between skin stretching/contraction and pathologic scarring: the important role of mechanical forces in keloid generation. Wound Repair Regen 20(2):149–157
pubmed: 22332721
doi: 10.1111/j.1524-475X.2012.00766.x
Harn HI, Ogawa R, Hsu CK, Hughes MW, Tang MJ, Chuong CM (2019) The tension biology of wound healing. Exp Dermatol 28(4):464–471
pubmed: 29105155
doi: 10.1111/exd.13460
Park TH, Chang CH (2012) Keloid recurrence in pregnancy. Aesthet Plast Surg 36(5):1271–1272
doi: 10.1007/s00266-012-9947-5
Kim HD, Hwang SM, Lim KR, Jung YH, Ahn SM, Kim SJ (2013) Recurrent auricular keloids during pregnancy. Arch Plast Surg 40(1):70–72
pubmed: 23362485
pmcid: 3556539
doi: 10.5999/aps.2013.40.1.70
Arima J, Huang C, Rosner B, Akaishi S, Ogawa R (2015) Hypertension: a systemic key to understanding local keloid severity. Wound Repair Regen. 23(2):213–221
pubmed: 25728259
doi: 10.1111/wrr.12277
Dong X, Mao S, Wen H (2013) Upregulation of proinflammatory genes in skin lesions may be the cause of keloid formation (Review). Biomed Rep 1(6):833–836
pubmed: 24649037
pmcid: 3917036
doi: 10.3892/br.2013.169
Marneros AG, Norris JE, Olsen BR, Reichenberger E (2001) Clinical genetics of familial keloids. Arch Dermatol 137(11):1429–1434
pubmed: 11708945
doi: 10.1001/archderm.137.11.1429
Nakashima M, Chung S, Takahashi A, Kamatani N, Kawaguchi T, Tsunoda T et al (2010) A genome-wide association study identifies four susceptibility loci for keloid in the Japanese population. Nat Genet 42(9):768–771
pubmed: 20711176
doi: 10.1038/ng.645
Ogawa R, Watanabe A, Than Naing B, Sasaki M, Fujita A, Akaishi S et al (2014) Associations between keloid severity and single-nucleotide polymorphisms: importance of rs8032158 as a biomarker of keloid severity. J Invest Dermatol 134(7):2041–2043
pubmed: 24496234
doi: 10.1038/jid.2014.71
Fujita M, Yamamoto Y, Jiang JJ, Atsumi T, Tanaka Y, Ohki T et al (2019) NEDD4 Is involved in inflammation development during keloid formation. J Invest Dermatol 139(2):333–341
pubmed: 30273597
doi: 10.1016/j.jid.2018.07.044
Abdu Allah AMK, Mohammed KI, Farag AGA, Hagag MM, Essam M, Tayel NR (2019) Interleukin-6 serum level and gene polymorphism in keloid patients. Cell Mol Biol Noisy Grand 65(5):43–48
doi: 10.14715/cmb/2019.65.5.7
Chen Y, Gao JH, Liu XJ, Yan X, Song M (2006) Characteristics of occurrence for Han Chinese familial keloids. Burns 32(8):1052–1059
pubmed: 17045405
doi: 10.1016/j.burns.2006.04.014
Hosalkar H, Greenberg J, Gaugler RL, Garg S, Dormans JP (2007) Abnormal scarring with keloid formation after osteochondroma excision in children with multiple hereditary exostoses. J Pediatr Orthop 27(3):333–337
pubmed: 17414021
doi: 10.1097/BPO.0b013e3180326732
Miller MC, Nanchahal J (2005) Advances in the modulation of cutaneous wound healing and scarring. Bio Drugs 19(6):363–381
Ogawa R, Miyashita T, Hyakusoku H, Akaishi S, Kuribayashi S, Tateno A (2007) Postoperative radiation protocol for keloids and hypertrophic scars: statistical analysis of 370 sites followed for over 18 months. Ann Plast Surg 59(6):688–691
pubmed: 18046154
doi: 10.1097/SAP.0b013e3180423b32
Reiffel RS (1995) Prevention of hypertrophic scars by long-term paper tape application. Plast Reconstr Surg 96(7):1715–1718
pubmed: 7480297
doi: 10.1097/00006534-199512000-00031
Son D, Harijan A (2014) Overview of surgical scar prevention and management. J Korean Med Sci 29(6):751–757
pubmed: 24932073
pmcid: 4055805
doi: 10.3346/jkms.2014.29.6.751
Lubczynska A, Garncarczyk A, Wcislo-Dziadecka D (2023) Effectiveness of various methods of manual scar therapy. Skin Res Technol 29(3):e13272
pubmed: 36973982
pmcid: 10155853
doi: 10.1111/srt.13272
Singapore Government (2022) Health sciences authority Singapore [cited 2022 24th August 2022]. Available from: https://www.hsa.gov.sg/
Monstrey S, Middelkoop E, Vranckx JJ, Bassetto F, Ziegler UE, Meaume S et al (2014) Updated scar management practical guidelines: non-invasive and invasive measures. J Plast Reconstr Aesthet Surg 67(8):1017–1025
pubmed: 24888226
doi: 10.1016/j.bjps.2014.04.011
Kim S, Choi TH, Liu W, Ogawa R, Suh JS, Mustoe TA (2013) Update on scar management: guidelines for treating Asian patients. Plast Reconstr Surg 132(6):1580–1589
pubmed: 24281584
doi: 10.1097/PRS.0b013e3182a8070c
O’Brien L, Jones DJ (2013) Silicone gel sheeting for preventing and treating hypertrophic and keloid scars. Cochr Database Syst Rev 2013(9):003826
Hsu KC, Luan CW, Tsai YW (2017) Review of silicone gel sheeting and silicone gel for the prevention of hypertrophic scars and keloids. Wounds 29(5):154–158
pubmed: 28570253
Chan KY, Lau CL, Adeeb SM, Somasundaram S, Nasir-Zahari M (2005) A randomized, placebo-controlled, double-blind, prospective clinical trial of silicone gel in prevention of hypertrophic scar development in median sternotomy wound. Plast Reconstr Surg 116(4):1013–20
pubmed: 16163087
doi: 10.1097/01.prs.0000178397.05852.ce
Sharma M, Wakure A (2013) Scar revision. Indian J Plast Surg. 46(2):408–418
pubmed: 24516292
pmcid: 3901922
doi: 10.4103/0970-0358.118621
Jourdan M, Madfes DC, Lima E, Tian Y, Seite S (2019) Skin care management for medical and aesthetic procedures to prevent scarring. Clin Cosmet Investig Dermatol 12:799–804
pubmed: 31695468
pmcid: 6820568
doi: 10.2147/CCID.S218134
Commander SJ, Chamata E, Cox J, Dickey RM, Lee EI (2016) Update on postsurgical scar management. Semin Plast Surg 30(3):122–128
pubmed: 27478420
pmcid: 4961501
doi: 10.1055/s-0036-1584824
Cho JW, Cho SY, Lee SR, Lee KS (2010) Onion extract and quercetin induce matrix metalloproteinase-1 in vitro and in vivo. Int J Mol Med 25(3):347–352
pubmed: 20127038
Jenwitheesuk K, Surakunprapha P, Jenwitheesuk K, Kuptarnond C, Prathanee S, Intanoo W (2012) Role of silicone derivative plus onion extract gel in presternal hypertrophic scar protection: a prospective randomized, double blinded, controlled trial. Int Wound J 9(4):397–402
pubmed: 22168750
doi: 10.1111/j.1742-481X.2011.00898.x
Khansa I, Harrison B, Janis JE (2016) Evidence-based scar management: how to improve results with technique and technology. Plast Reconstr Surg 138(3 Suppl):165S-S178
pubmed: 27556757
doi: 10.1097/PRS.0000000000002647
Hosnuter M, Payasli C, Isikdemir A, Tekerekoglu B (2007) The effects of onion extract on hypertrophic and keloid scars. J Wound Care 16(6):251–254
pubmed: 17722521
doi: 10.12968/jowc.2007.16.6.27070
Chung VQ, Kelley L, Marra D, Jiang SB (2006) Onion extract gel versus petrolatum emollient on new surgical scars: prospective double-blinded study. Dermatol Surg 32(2):193–197
pubmed: 16442038
Gold MH, Berman B, Clementoni MT, Gauglitz GG, Nahai F, Murcia C (2014) Updated international clinical recommendations on scar management: part 1–evaluating the evidence. Dermatol Surg 40(8):817–824
pubmed: 25068543
Shin TM, Bordeaux JS (2012) The role of massage in scar management: a literature review. Dermatol Surg 38(3):414–423
pubmed: 22093081
doi: 10.1111/j.1524-4725.2011.02201.x
Aarabi S, Bhatt KA, Shi Y, Paterno J, Chang EI, Loh SA et al (2007) Mechanical load initiates hypertrophic scar formation through decreased cellular apoptosis. Faseb J 21(12):3250–3261
pubmed: 17504973
doi: 10.1096/fj.07-8218com
Berman B, Viera MH, Amini S, Huo R, Jones IS (2008) Prevention and management of hypertrophic scars and keloids after burns in children. J Craniofac Surg 19(4):989–1006
pubmed: 18650721
doi: 10.1097/SCS.0b013e318175f3a7
Ai JW, Liu JT, Pei SD, Liu Y, Li DS, Lin HM et al (2017) The effectiveness of pressure therapy (15–25 mmHg) for hypertrophic burn scars: a systematic review and meta-analysis. Sci Rep 7:40185
pubmed: 28054644
pmcid: 5215680
doi: 10.1038/srep40185
Macintyre L, Baird M (2006) Pressure garments for use in the treatment of hypertrophic scars—a review of the problems associated with their use. Burns 32(1):10–15
pubmed: 16413399
doi: 10.1016/j.burns.2004.06.018
Ketchum LD, Smith J, Robinson DW, Masters FW (1966) The treatment of hypertrophic scar, keloid and scar contracture by triamcinolone acetonide. Plast Reconstr Surg 38(3):209–218
pubmed: 5919604
doi: 10.1097/00006534-196609000-00005
Morelli Coppola M, Salzillo R, Segreto F, Persichetti P (2018) Triamcinolone acetonide intralesional injection for the treatment of keloid scars: patient selection and perspectives. Clin Cosmet Investig Dermatol 11:387–396
pubmed: 30087573
pmcid: 6063260
doi: 10.2147/CCID.S133672
Roques C, Teot L (2008) The use of corticosteroids to treat keloids: a review. Int J Low Extrem Wounds 7(3):137–145
pubmed: 18611924
doi: 10.1177/1534734608320786
Tan CWX, Tan WD, Srivastava R, Yow AP, Wong DWK, Tey HL (2019) Dissolving triamcinolone-embedded microneedles for the treatment of keloids: a single-blinded intra-individual controlled clinical trial. Dermatol Ther Heidelb 9(3):601–611
pubmed: 31376063
pmcid: 6704225
doi: 10.1007/s13555-019-00316-3
Kasyanju Carrero LM, Ma WW, Liu HF, Yin XF, Zhou BR (2019) Botulinum toxin type A for the treatment and prevention of hypertrophic scars and keloids: Updated review. J Cosmet Dermatol 18(1):10–15
pubmed: 30548742
doi: 10.1111/jocd.12828
Li YH, Yang J, Liu JQ, Xie ST, Zhang YJ, Zhang W et al (2018) A randomized, placebo-controlled, double-blind, prospective clinical trial of botulinum toxin type A in prevention of hypertrophic scar development in median sternotomy wound. Aesthetic Plast Surg 42(5):1364–1369
pubmed: 30019241
doi: 10.1007/s00266-018-1187-x
Huang RL, Ho CK, Tremp M, Xie Y, Li Q, Zan T (2019) Early postoperative application of botulinum toxin type A prevents hypertrophic scarring after epicanthoplasty: a split-face, double-blind. Randomized Trial Plast Reconstr Surg 144(4):835–844
pubmed: 31568286
doi: 10.1097/PRS.0000000000006069
Bi M, Sun P, Li D, Dong Z, Chen Z (2019) Intralesional injection of botulinum toxin type A compared with intralesional injection of corticosteroid for the treatment of hypertrophic scar and keloid: a systematic review and meta-analysis. Med Sci Monit 25:2950–2958
pubmed: 31006769
pmcid: 6489528
doi: 10.12659/MSM.916305
Wu WTL (2011) Skin resurfacing with Microbotox and the treatment of keloids. In: Benedetto AV (ed) Botulinum toxins in clinical aesthetic practice, 2nd edn. Informa Health Care, pp 190–205
Khoury JG, Saluja R, Goldman MP (2008) The effect of botulinum toxin type A on full-face intense pulsed light treatment: a randomized, double-blind, split-face study. Dermatol Surg 34(8):1062–1069
pubmed: 18462423
Gamil HD, Khattab FM, El Fawal MM, Eldeeb SE (2020) Comparison of intralesional triamcinolone acetonide, botulinum toxin type A, and their combination for the treatment of keloid lesions. J Dermatol Treat 31(5):535–544
doi: 10.1080/09546634.2019.1628171
Bouzari N, Davis SC, Nouri K (2007) Laser treatment of keloids and hypertrophic scars. Int J Dermatol 46(1):80–88
pubmed: 17214728
doi: 10.1111/j.1365-4632.2007.03104.x
Al-Mohamady Ael S, Ibrahim SM, Muhammad MM (2016) Pulsed dye laser versus long-pulsed Nd:YAG laser in the treatment of hypertrophic scars and keloid: a comparative randomized split-scar trial. J Cosmet Laser Ther 18(4):208–212
doi: 10.3109/14764172.2015.1114648
Kono T, Ercocen AR, Nakazawa H, Honda T, Hayashi N, Nozaki M (2003) The flashlamp-pumped pulsed dye laser (585 nm) treatment of hypertrophic scars in Asians. Ann Plast Surg 51(4):366–371
pubmed: 14520063
doi: 10.1097/01.SAP.0000067722.07175.62
Jin R, Huang X, Li H, Yuan Y, Li B, Cheng C et al (2013) Laser therapy for prevention and treatment of pathologic excessive scars. Plast Reconstr Surg 132(6):1747–1758
pubmed: 24281600
doi: 10.1097/PRS.0b013e3182a97e43
Koike S, Akaishi S, Nagashima Y, Dohi T, Hyakusoku H, Ogawa R (2014) Nd:YAG laser treatment for keloids and hypertrophic scars: an analysis of 102 cases. Plast Reconstr Surg Glob Open 2(12):e272
pubmed: 25587506
doi: 10.1097/GOX.0000000000000231
Tsai CH, Kao HK, Akaishi S, An-Jou Lin J, Ogawa R (2020) Combination of 1,064-nm neodymium-doped yttrium aluminum garnet laser and steroid tape decreases the total treatment time of hypertrophic scars: an analysis of 40 cases of cesarean-section scars. Dermatol Surg 46(8):1062–1067
pubmed: 31702591
doi: 10.1097/DSS.0000000000002235
Khatri KA, Mahoney DL, McCartney MJ (2011) Laser scar revision: a review. J Cosmet Laser Ther 13(2):54–62
pubmed: 21401378
doi: 10.3109/14764172.2011.564625
Seegenschmiedt MH, Micke O, Niewald M, Mucke R, Eich HT, Kriz J et al (2015) Degro guidelines for the radiotherapy of non-malignant disorders: part III: hyperproliferative disorders. Strahlenther Onkol 191(7):541–548
pubmed: 25753848
doi: 10.1007/s00066-015-0818-2
Ogawa R, Tosa M, Dohi T, Akaishi S, Kuribayashi S (2019) Surgical excision and postoperative radiotherapy for keloids. Scars Burn Heal. 5:2059513119891113
pubmed: 31840001
pmcid: 6904783
Ogawa R (2022) The most current algorithms for the treatment and prevention of hypertrophic scars and keloids: a 2020 update of the algorithms published 10 years ago. Plast Reconstr Surg 149(1):79e–94e
pubmed: 34813576
doi: 10.1097/PRS.0000000000008667
Arima J, Dohi T, Kuribayashi S, Akaishi S, Ogawa R (2019) Z-plasty and postoperative radiotherapy for anterior chest wall keloids: an analysis of 141 patients. Plast Reconstr Surg Glob Open 7(3):e2177
pubmed: 31044131
pmcid: 6467632
doi: 10.1097/GOX.0000000000002177
Dohi T, Kuribayashi S, Tosa M, Aoki M, Akaishi S, Ogawa R (2019) Z-plasty and postoperative radiotherapy for upper-arm keloids: an analysis of 38 patients. Plast Reconstr Surg Glob Open 7(11):e2496
pubmed: 31942294
pmcid: 6908330
doi: 10.1097/GOX.0000000000002496
Al Aradi IK, Alawadhi SA, Alkhawaja FA, Alaradi I (2013) Earlobe keloids: a pilot study of the efficacy of keloidectomy with core fillet flap and adjuvant intralesional corticosteroids. Dermatol Surg 39(10):1514–1519
pubmed: 23876009
doi: 10.1111/dsu.12262
Akita S, Akino K, Yakabe A, Imaizumi T, Tanaka K, Anraku K et al (2007) Combined surgical excision and radiation therapy for keloid treatment. J Craniofac Surg 18(5):1164–1169
pubmed: 17912105
doi: 10.1097/scs.0b013e3180de62a1
Singapore Department of Statistics (2020) Census of population 2020 statistical release 1. Available from: https://www.singstat.gov.sg/-/media/files/publications/cop2020/sr1/findings.pdf
Alhady SM, Sivanantharajah K (1969) Keloids in various races. A review of 175 cases. Plast Reconstr Surg 44(6):564–6
pubmed: 5352921
doi: 10.1097/00006534-196912000-00006