WOUND HEALING ,KELOIDS AND HYPERTROPHIC SCARS BY DR ABRAHAM.pptx

REVIEW OF WOUND HEALING , FORMATION OF KELOID SCARS AND HYPERTROPHIC SCARS

1. WOUND HEALING ,KELOIDS AND HYPERTROPHIC SCARS Dr. Abraham mukalazi MbchB (MUK) MMED (MUST) A&E DERMATOLOGY SPECIALISTS

2. Introduction to Wound Healing Overview : Definition of wound healing Importance of wound healing in maintaining skin integrity Brief outline of the process

3. Phases of Wound Healing Hemostasis : Occurs immediately after injury Blood clot formation and vasoconstriction Inflammatory Phase : Inflammation and immune response- nuetrophils Cleaning the wound site of debris and bacteria Proliferative Phase : Formation of new tissue (granulation tissue ) – macrophages, fibroblasts Angiogenesis and re-epithelialization Maturation/Remodeling Phase : Collagen remodeling and strengthening Scar tissue formation

4. Healing by Primary Intention Definition : Healing of clean, closely approximated wounds (e.g., surgical incisions) Characteristics : Minimal tissue loss Direct closure of wound edges Faster healing and minimal scarring Examples : Surgical wounds Paper cuts

5. Healing by Secondary Intention Definition : Healing of wounds with significant tissue loss or infection Characteristics : Open wound healing Slower process due to the need for granulation tissue formation Increased risk of scarring Examples : Burns Pressure ulcers Infected wounds

6. Comparison Between Primary and Secondary Intention Primary Intention : Faster healing, less scarring Secondary Intention : Slower healing, greater risk of infection and scarring Key Differences : Tissue loss, healing time, and scar formation

7. Keloids Definition : Thick, raised scars that extend beyond the boundaries of the original wound SYN. Cheloid ( clawlike prolongations) Incidence 1-16% in Africans, M=F Characteristics : Excessive collagen production Can be itchy or painful Typically do not regress over time Common Locations : Shoulders, chest, earlobes, and cheeks Risk Factors : Genetic predisposition (more common in darker-skinned individuals) Wound tension, infection, or delayed healing,hormonal influence

8. Keloids – Pathophysiology Mechanism : Dysregulation of wound healing, leading to excessive fibroblast activity Increased collagen deposition Molecular Factors : Overexpression of TGF- β 1 ( transforming growth factor-beta) Increased fibroblast proliferation Collagen in keloid Type 1 (80-90%) Types III (10-20%) Type VI – small amounts but plays a role in development

9. Hypertrophic Scars Definition : Thick, raised scars that remain within the boundaries of the original wound Characteristics : Can be red and raised but usually improve over time Less aggressive compared to keloids Respond better to treatment Risk Factors : Increased tension on the wound Delayed healing or infection

10. Keloids vs. Hypertrophic Scars Keloids : Extend beyond wound boundaries Do not regress More difficult to treat Hypertrophic Scars : Stay within wound boundaries May regress over time Easier to manage

11. Treatment of Keloids Non-Surgical Options : Steroid injections (reduce inflammation and fibroblast activity) Pressure therapy (use of compression garments) Silicone sheets or gels Cryotherapy (freezing of the scar tissue) Surgical Options : Excision (cutting out the keloid) Risk of recurrence unless combined with other treatments (e.g., radiation therapy)

12. Treatment of Hypertrophic Scars Non-Surgical Options : Steroid injections or topical applications Silicone sheets or gels Pressure therapy Surgical Options : Scar revision surgery Laser therapy

13. Preventing Abnormal Scarring Key Strategies : Proper wound care to prevent infection Minimizing wound tension during healing Early intervention with silicone sheets or gels Use of pressure garments after surgery or injury

14. Complications of Keloids and Hypertrophic Scars Keloids : Functional Impairment : Large keloids, especially on joints, can limit mobility (e.g., keloids on elbows, knees). Chronic Pain and Itching : Persistent discomfort, tenderness, and pruritus (itchiness) over the keloid. Cosmetic Concerns : Prominent and disfiguring scars, particularly on visible areas (e.g., face, neck, earlobes). Psychological Impact : Emotional distress, reduced self-esteem due to unsightly appearance. Recurrence after Treatment : High rates of recurrence, even after surgical excision, especially if not combined with adjunct therapies. Infections : Scars can be infected with bacteria .

15. Conclusion Summary of the phases of wound healing Key differences between healing by primary and secondary intention Importance of understanding keloids and hypertrophic scars for effective treatment