Consequences of thermal and chemical burns, frostbite, wounds. Consequences of thermal and chemical burns, frostbite, wounds Keloid scars, microbial code 10

The formation of scar tissue is a physiological response to damage to the skin and mucous membranes. However, changes in the metabolism of the extracellular matrix (an imbalance between its destruction and synthesis) can lead to excessive scarring and the formation of keloid and hypertrophic scars.

Wound healing, and hence scar tissue formation, involves three distinct steps: inflammation (in the first 48-72 hours after tissue injury), proliferation (up to 6 weeks), and remodeling or maturation (over 1 year or more). A prolonged or excessively pronounced inflammatory phase can contribute to increased scarring. According to the results of modern research, in people with a genetic predisposition, the first blood group, IV-V-VI skin phototype, scarring can develop under the influence of various factors: IgE hyperimmunoglobulinemia, changes in hormonal status (during puberty, pregnancy, etc.) .

A key role in the formation of a keloid scar is played by abnormal fibroblasts and transforming growth factor - β1. In addition, in the tissues of keloid scars, an increase in the number of mast cells associated with an increased level of such fibrosis promoters as hypoxia-induced factor-1α, vascular endothelial growth factor, and plasminogen activator inhibitor-1 is determined.

In the development of hypertrophic scars, the main role is played by the violation of the metabolism of the extracellular matrix of the newly synthesized connective tissue: hyperproduction and violation of the processes of remodeling of the extracellular matrix with increased expression of type I and III collagen. In addition, disruption of the hemostasis system promotes excessive neovascularization and prolongs reepithelialization time.

There are no official figures for the incidence and prevalence of keloid and hypertrophic scars. According to modern research, scarring occurs in 1.5-4.5% of individuals in the general population. Keloid scars are detected equally in men and women, more often in young people. There is a hereditary predisposition to the development of keloid scars: genetic studies indicate an autosomal dominant inheritance with incomplete penetrance.

Skin scar classification:

There is no generally accepted classification.

Clinical picture (symptoms) of skin scars:

There are the following clinical forms of scars:

• normotrophic scars;
• atrophic scars;
• hypertrophic scars:
• linear hypertrophic scars;
• widespread hypertrophic scars;
• small keloid scars;
• large keloid scars.

There are also stable (mature) and unstable (immature) scars.

Keloid scars are well-defined, firm nodules or plaques, pink to purple in color, with a smooth surface and uneven, indistinct borders. Unlike hypertrophic scars, they are often accompanied by soreness and hyperesthesia. The thin epidermis covering scars is often ulcerated, and hyperpigmentation is often observed.

Keloid scars form no earlier than 3 months after tissue damage, and then can increase in size for an indefinitely long time. As the pseudotumor grows with deformation of the focus, they go beyond the boundaries of the original wound, do not spontaneously regress, and tend to recur after excision.

The formation of keloid scars, including spontaneous, is observed in certain anatomical areas (earlobes, chest, shoulders, upper back, back of the neck, cheeks, knees).

Hypertrophic scars are dome-shaped nodes of various sizes (from small to very large), with a smooth or bumpy surface. Fresh scars have a reddish color, later it becomes pinkish, whitish. Hyperpigmentation is possible along the edges of the scar. Scar formation occurs within the first month after tissue damage, an increase in size - within the next 6 months; often scars regress within 1 year. Hypertrophic scars are limited to the boundaries of the original wound and, as a rule, retain their shape. Lesions are usually localized on the extensor surfaces of the joints or in areas subject to mechanical stress.

Diagnosis of skin scars:

The diagnosis of the disease is established on the basis of the clinical picture, the results of dermatoscopic and histological studies (if necessary).
When carrying out combination therapy, consultations of a therapist, plastic surgeon, traumatologist, radiologist are recommended.

Differential Diagnosis

Keloid scar	Hypertrophic scar
Infiltrating growth beyond the original lesion	Growth within the original damage
Spontaneous or post-traumatic	Only post-traumatic
Predominant anatomical regions (earlobes, chest, shoulders, upper back, back of the neck, cheeks, knees)	There are no predominant anatomical regions (but are usually located on the extensor surfaces of the joints or in areas subject to mechanical stress)
Appear 3 months or later after tissue damage, may increase in size indefinitely	Appear within the first month after tissue damage, may increase in size within 6 months, often regress within 1 year.
Not associated with contractures	Associated with contractures
Itching and severe pain	Subjective sensations are rare
Skin phototype IV and above	No relation to skin phototype
Genetic predisposition (autosomal dominant inheritance, localization on chromosomes 2q23 and 7p11)	No genetic predisposition
Thick collagen fibers	Thin collagen fibers
Absence of myofibroblasts and α-SMA	Presence of myofibroblasts and α-SMA
Type I Collagen > Type III Collagen	type I collagen< коллаген III типа
Hyperexpression of COX-2	Hyperexpression of COX-1

Skin Scar Treatment:

Treatment Goals

• stabilization of the pathological process;
• achieving and maintaining remission;
• improving the quality of life of patients:
• relief of subjective symptoms;
• correction of functional insufficiency;
• achieving the desired cosmetic result.

General notes on therapy

Hypertrophic and keloid scars are benign skin lesions. The need for therapy is determined by the severity of subjective symptoms (eg, itching/pain), functional deficiency (eg, contractures/mechanical irritation due to the height of the formations), and aesthetic indicators, which can significantly affect the quality of life and lead to stigmatization.

None of the currently available methods of scar therapy in the form of monotherapy allows in all cases to achieve a reduction in scars or an improvement in the functional state and / or cosmetic situation. In almost all clinical situations, a combination of different treatments is required.

Medical therapy

Intralesional administration of glucocorticosteroid drugs

• triamcinolone acetonide 1 mg per cm 2 intralesional (30 gauge needle 0.5 inch long). The total number of injections is individual and depends on the severity of the therapeutic response and possible side effects. Intralesional administration of triamcinolone acetonide after surgical excision of the scar prevents recurrence.
• betamethasone dipropionate (2 mg) + betamethasone disodium phosphate (5 mg): 0.2 ml per 1 cm 2 intralesion. The lesion is evenly punctured using a tuberculin syringe and a 25-gauge needle.

Non-drug therapy

Cryosurgery

Liquid nitrogen cryosurgery results in complete or partial reduction of 60-75% of keloid scars after at least three sessions (B). The main side effects of cryosurgery are hypopigmentation, blistering, and delayed healing.

The combination of cryosurgery with liquid nitrogen and injections of glucocorticosteroid drugs has a synergistic effect due to a more uniform distribution of the drug as a result of intercellular edema of the scar tissue after low-temperature exposure.

The treatment of the scar can be carried out by the method of open cryopreservation or by the contact method using a cryoprobe. Exposure time - at least 30 seconds; frequency of use - 1 time in 3-4 weeks, the number of procedures - individually, but not less than 3.

• Carbon dioxide laser.

Treatment of the scar with a CO 2 laser can be carried out in total or fractional modes. After total ablation of a keloid scar with a CO2 laser as monotherapy, recurrence is observed in 90% of cases, so this type of treatment cannot be recommended as monotherapy. The use of fractional laser exposure modes can reduce the number of relapses.

• Pulsating dye laser.

The pulsed dye laser (PDL) generates radiation at a wavelength of 585 nm, which corresponds to the absorption peak of erythrocyte hemoglobin in blood vessels. In addition to direct vascular effects, PDL reduces the induction of transforming growth factor-β1 (TGF-β1) and the overexpression of matrix metalloproteinases (MMPs) in keloid tissues.

In most cases, the use of PDL has a positive effect on the scar tissue in the form of softening, reducing the intensity of erythema and standing height.

Surgical correction of cicatricial changes is accompanied by a recurrence in 50-100% of cases, with the exception of earlobes keloids, which recur much less frequently. This situation is associated with the peculiarities of the operating technique, the choice of the method of closing the surgical defect, and various options for plasty with local tissues.

Radiation therapy

It is used as monotherapy or as an adjunct to surgical excision. Surgical correction within 24 hours of radiation therapy is considered the most effective approach for the treatment of keloid scars, which can significantly reduce the number of recurrences. The use of relatively high doses of radiation therapy for a short exposure time is recommended.

Adverse reactions to ionizing radiation include persistent erythema, skin desquamation, telangiectasias, hypopigmentation, and the risk of carcinogenesis (there are several scientific reports of malignant transformation following radiotherapy of scars).

Requirements for treatment outcomes

Depending on the method of therapy, positive clinical dynamics (30-50% reduction in scar volume, reduction in the severity of subjective symptoms) can be achieved after 3-6 procedures or after 3-6 months of treatment.

In the absence of satisfactory results of treatment after 3-6 procedures / 3-6 months, modification of therapy is necessary (combination with other methods / change of method / increase in dose).

Prevention of skin scar formation:

Individuals with a history of hypertrophic or keloid scarring, or those undergoing surgery in an area at increased risk of developing them, are advised to:

• For wounds with a high risk of scarring, silicone-based products are preferred. Silicone gel or sheets should be applied after the incision or wound has epithelialized and continued for at least 1 month. For silicone gel, a minimum of 12-hour daily use or, if possible, continuous 24-hour use with twice-daily hygiene is recommended. The use of silicone gel may be preferable for large area lesions, when used on their facial area, for individuals living in hot and humid climates.
• For patients with an average risk of developing scars, it is possible to use silicone gel or plates (preferably), hypoallergenic microporous tape.
• Patients at low risk of developing scarring should be advised to follow standard hygiene procedures. If the patient expresses concern about the possibility of scar formation, he can apply silicone gel.

An additional general preventive measure is avoiding sun exposure and using sunscreens with a maximum sun protection factor (SPF > 50) until the scar matures.

As a rule, the management of patients with scars can be reviewed 4-8 weeks after epithelialization in order to determine the need for additional interventions to correct scars.

IF YOU HAVE ANY QUESTIONS REGARDING THIS DISEASE, PLEASE CONTACT DERMATOVENEROLOGIST ADAEV KH.M:

WHATSAPP 8 989 933 87 34

Email: [email protected]

INSTAGRAM @DERMATOLOG_95

Rough scars and scars on the face or body today no longer serve as an adornment for real men and, even more so, women. Unfortunately, the possibilities of modern medical cosmetology do not allow to completely get rid of cicatricial defects, offering only to make them less noticeable. The process of scar correction requires perseverance and patience.
"Scar" and "scar" are synonymous words. A scar is a household, everyday name for a scar. Scars on the body are formed due to the healing of various skin lesions. The impact of mechanical (trauma), thermal (burns) agents, skin diseases (post-acne) lead to a violation of the physiological structure of the skin and its replacement with connective tissue.
Sometimes scars behave very insidiously. With normal physiological scarring, the skin defect tightens and turns pale over time. But in some cases, scarring is pathological: the scar acquires a bright purple color and increases in size. In this case, the immediate help of a specialist is necessary. The problem of scar correction is dealt with in collaboration with dermatocosmetologists and plastic surgeons.

Scar formation.

In its formation, the scar goes through 4 consecutive stages: I - the stage of inflammation and epithelization.
It takes from 7 to 10 days from the moment of the injury. It is characterized by a gradual decrease in swelling and inflammation of the skin. Granulation tissue is formed, bringing together the edges of the wound, the scar is still absent. If there is no infection or divergence of the wound surface, then the wound heals by primary intention with the formation of a barely noticeable thin scar. In order to prevent complications at this stage, atraumatic sutures are applied, sparing tissues, daily dressings are performed with local antiseptics. Physical activity is limited to avoid divergence of the wound edges. II - stage of formation of a "young" scar.
Covers the period from the 10th to the 30th day from the moment of injury. It is characterized by the formation of collagen-elastin fibers in the granulation tissue. The scar is immature, loose, easily extensible, bright pink in color (due to increased blood supply to the wound). At this stage, secondary injury to the wound and increased physical exertion should be avoided. III - stage of formation of a "mature" scar.
It lasts from the 30th to the 90th day from the date of injury. Elastin and collagen fibers grow into bundles and line up in a certain direction. The blood supply to the scar is reduced, causing it to thicken and turn pale. At this stage, there are no restrictions on physical activity, but repeated trauma to the wound can cause the formation of a hypertrophic or keloid scar. IV - stage of the final transformation of the scar.
Starting from 4 months after the injury and up to a year, the final maturation of the scar occurs: the death of blood vessels, the tension of collagen fibers. The scar thickens and turns pale. It is during this period that the doctor becomes clear about the condition of the scar and further tactics for its correction.
Getting rid of scars once and for all is not possible. With the help of modern techniques, you can only make a rough, wide scar cosmetically more acceptable. The choice of technique and the effectiveness of treatment will depend on the stage of formation of the scar defect and on the type of scar. At the same time, the rule applies: the earlier you seek medical help, the better the result will be.
The scar is formed as a result of a violation of the integrity of the skin (surgery, trauma, burns, piercing) as a result of the processes of closing the defect with new connective tissue. Superficial damage to the epidermis heals without scarring, i.e. The cells of the basal layer have a good regenerative capacity. The deeper the damage to the layers of the skin, the longer the healing process and the more pronounced the scar. Normal, uncomplicated scarring results in a normotrophic scar that is flat and has the color of the surrounding skin. Violation of the course of scarring at any stage can lead to the formation of a rough pathological scar.

Scar types.

Before choosing a treatment method and the optimal duration of a particular procedure, it is necessary to determine the type of scars.
Normotrophic scars usually do not cause great distress to patients. They are not so noticeable, because their elasticity is close to normal, they are pale or flesh-colored and are at the level of the surrounding skin. Without resorting to radical methods of treatment, such scars can be safely removed with the help of microdermabrasion or chemical superficial peeling.
Atrophic scars can occur due to acne or poor-quality removal of moles or papillomas. Stretch marks (striae) are also this type of scarring. Atrophic scars are below the level of the surrounding skin, characterized by tissue laxity due to a decrease in collagen production. The lack of skin growth leads to the formation of pits and scars, creating a visible cosmetic defect. Modern medicine has in its arsenal many effective ways to eliminate even fairly extensive and deep atrophic scars.
Hypertrophic scars are pink in color, limited to the damaged area and protrude above the surrounding skin. Hypertrophic scars may partially disappear from the surface of the skin within two years. They respond well to treatment, so do not wait for their spontaneous disappearance. Small scars can be affected by laser resurfacing, dermabrasion, chemical peeling. The introduction of hormonal preparations, injections of diprospan and kenalog into the scar zone leads to positive results. Electro- and ultraphonophoresis with contractubex, lidase, hydrocortisone give a stable positive effect in the treatment of hypertrophic scars. Surgical treatment is possible, in which scar tissue is excised. This method gives the best cosmetic effect.
Keloid scars have a sharp border, protrude above the surrounding skin. Keloid scars are often painful, itching and burning are felt in the places of their formation. This type of scarring is difficult to treat, relapses of even larger keloid scars are possible. Despite the complexity of the task, aesthetic cosmetology has many examples of a successful solution to the problem of keloid scars.

Features of keloid scars.

The success of the treatment of any disease largely depends on the correct diagnosis. This rule is no exception in the case of elimination of keloid scars. To avoid mistakes in treatment tactics, it is possible only to clearly determine the type of scar, because in terms of external manifestations, keloid scars often resemble hypertrophic scars. The essential difference is that the size of hypertrophic scars coincides with the size of the damaged surface, while keloid scars go beyond the boundaries of the injury and may exceed the size of the traumatic skin injury in area. The usual places of occurrence of keloid scars are the chest area, the auricles, less often the joints and the face area. Keloid scars go through four stages in their development.
stage of epithelialization. After an injury, the damaged area is covered with a thin epithelial film, which thickens, coarsens, becomes pale in color within 7-10 days and remains in this form for 2-2.5 weeks.
swelling stage. At this stage, the scar increases, rises above the adjacent skin, becomes painful. In the course of 3-4 weeks, the pain sensations subside, and the scar acquires a more intense reddish color with a cyanotic tint.
Compaction stage. There is a compaction of the scar, in some places there are dense plaques, the surface becomes bumpy. The external picture of the scar is a keloid.
softening stage. At this stage, the scar finally acquires a keloid character. It is distinguished by its pale color, softness, mobility and painlessness.
When choosing treatment tactics, they proceed from the statute of limitations of scars. Keloid scars from 3 months to 5 years of existence (young keloids) are actively growing, have a smooth shiny surface, red with a cyanotic tint. Scars older than 5 years (old keloids) turn pale, acquire a wrinkled uneven surface (sometimes the central part of the scar sinks).
Keloid scars can be caused by surgery, vaccinations, burns, insect or animal bites, and tattoos. Such scars can occur even without traumatic injury. In addition to significant aesthetic discomfort, keloid scars give patients unpleasant sensations of itching and soreness. The reason for the development of this particular type of scars, and not hypertrophic ones, has not been established by physicians at the moment.

A little about scarification.

Information about scars will be incomplete if we pass over in silence such a procedure as scarification or scarification - artificial application of decorative scars on the skin. For some, this newfangled direction of body art is a way to disguise existing scars, for others it is an attempt to give their appearance masculinity and brutality. Unfortunately, the thoughtless passion of young people for such procedures, as well as other artificial skin injuries (tattoos, piercings) leads to irreversible consequences. Fashion passes, but scars remain forever.

Infiltration after surgery is one of the most common complications after surgery. It can develop after any operation - if you have an appendix removed, a hernia removed, or even just an injection.

Therefore, it is important to carefully monitor your condition after surgery. It is quite simple to cure such a complication if it is diagnosed in time. But if tightened, it can develop into an abscess, and this is already fraught with an abscess breakthrough and blood poisoning.

What it is?

The term itself is a fusion of two Latin words: in - "in" and filtratus - "strained". Doctors call this word a pathological process, when particles of cells (including blood cells), blood itself, and lymph accumulate inside tissues or any organ. Outwardly, it looks like a dense formation, but simply a tumor.

There are 2 main forms of this phenomenon - inflammatory (this is usually the complications after surgery) and tumor. Inside the second formation is not innocent blood and lymph, but tumor cells, and very often cancerous ones. Sometimes doctors call an infiltrate an area on the body where an anesthetic, antibiotic or other substances are injected during treatment. This type is called "surgical".

The inflammatory process can begin even before the operation. Particularly often diagnosed is appendicular infiltrate, which develops almost in parallel with inflammation of the appendix. It is even more common than a complication after appendicitis surgery. Another "popular" option is a tumor in the mouth of children, the reason is fibrous pulpitis.

Varieties

Inflammatory infiltrate is the main type of such a pathology, which often appears after surgery. There are several types of such inflammation, depending on which cells inside the tumor are the most.

1. Purulent (polymorphonuclear leukocytes gathered inside).
2. Hemorrhagic (erythrocytes).
3. Round cell, or lymphoid (lymphoid cells).
4. Histiocytic-plasmocellular (inside plasma elements and histiocytes).

Inflammation of any nature can develop in several directions - either resolve over time (in 1-2 months), or turn into an ugly scar, or develop into an abscess.

Scientists consider postoperative suture infiltrate to be a special kind of inflammatory. Such a disease is especially insidious - it can "jump out" in a week or two after the operation, and after 2 years. The second option happens, for example, after a caesarean section, and the risk that the inflammation develops into an abscess is quite high.

Causes

From the appearance of purulent, hemorrhagic and other formations after surgery, no one is immune. The complication occurs in both young children and adult patients, after banal appendicitis and after hysterectomy(paracervical and other tumors).

Experts name 3 main reasons for this phenomenon - trauma, odontogenic infections (in the oral cavity) and other infectious processes. If you went to the doctor because the postoperative suture became inflamed, a number of more reasons are added:

• an infection has entered the wound;
• postoperative drainage was incorrectly performed (usually in overweight patients);
• due to the fault of the surgeon, the layer of subcutaneous fatty tissue was damaged, and a hematoma appeared;
• suture material has a high tissue reactivity.

If the scar becomes inflamed only a few months or years after surgical procedures, it is the suture material that is to blame. Such a pathology is called a ligature (a ligature is a dressing thread).

Pathology can also be provoked by a tendency to allergies in a patient, weak immunity, chronic infections, congenital diseases, etc.

Symptoms

A postoperative complication does not develop immediately - usually on the 4-6th day after hour X (surgical intervention). Sometimes even later - after one and a half to two weeks. The main signs of incipient inflammation in the wound are:

• subfebrile temperature (it rises by only a few divisions, but it is impossible to bring it down);
• when pressing on the inflamed area, pain is felt;
• if you press very hard, a small hole appears, which gradually straightens;
• the skin in the affected area swells and turns red.

If the swelling occurs after the operation to remove the inguinal hernia, other symptoms may also be added. About the pathological accumulation of cells in the abdominal cavity they will say:

• aching pain in the peritoneum;
• bowel problems (constipation);
• hyperemia (strong blood flow to sore spots).

With hyperemia, edema occurs and boils pop up, the heartbeat quickens, the patient suffers from headaches.

What is a post-injection infiltrate?

Infiltration after an injection is one of the most common complications after an injection, along with hematomas. It looks like a small dense bump in the place where the needle with the medicine was stuck. The predisposition to such a mini-complication is usually individual: someone has a seal on the skin after each injection, and someone has never encountered such a problem in their entire life.

The following reasons can provoke a similar reaction of the body to a banal injection:

• the nurse performed the antiseptic treatment poorly;
• the syringe needle is too short or blunt;
• wrong injection site;
• injections are constantly made in the same place;
• the medicine is administered too quickly.

Such a sore can be cured with conventional physiotherapy, iodine mesh or compresses with diluted dimexide. Folk methods will also help: compresses from cabbage leaves, aloe, burdock. For greater efficiency, before the compress, you can lubricate the cone with honey.

Diagnostics

It is usually not difficult to diagnose such postoperative pathology. When making a diagnosis, the doctor relies primarily on the symptoms: temperature (what and how long it lasts), the nature and intensity of pain, etc.

Most often, the tumor is determined by palpation - it is a dense formation with uneven and fuzzy edges, which responds with pain when palpated. But if surgical manipulations were performed on the abdominal cavity, then the seal can hide deep inside. And with a finger examination, the doctor simply will not find it.

In this case, more informative diagnostic methods come to the rescue - ultrasound and computed tomography.

Another mandatory diagnostic procedure is a biopsy. Tissue analysis will help to understand the nature of inflammation, find out which cells have accumulated inside, and determine whether any of them are malignant. This will allow you to find out the cause of the problem and correctly draw up a treatment regimen.

Treatment

The main goal in the treatment of postoperative infiltrate is to relieve inflammation and prevent the development of an abscess. To do this, you need to restore blood flow in a sore spot, relieve swelling and eliminate pain. First of all, conservative therapy is used:

1. Treatment with antibiotics (if the infection is caused by bacteria).
2. Symptomatic therapy.
3. Local hypothermia (artificial decrease in body temperature).
4. Physiotherapy.
5. Bed rest.

Effective procedures are considered to be UV irradiation of the wound, laser therapy, mud therapy, etc. The only contraindication for physiotherapy is purulent inflammation. In this case, heating and other procedures will only hasten the spread of infection and may cause an abscess.

When the first signs of an abscess appear, a minimally invasive intervention is first used - drainage of the affected area (under ultrasound control). In the most difficult cases, the abscess is opened in the usual way, using laparoscopy or laparotomy.

Treatment of a postoperative suture with complications is also traditionally carried out using conservative methods: antibiotics, novocaine blockade, physiotherapy. If the tumor has not resolved, the suture is opened, cleaned and sutured again.

An infiltrate after surgery can form in a patient of any age and health condition. By itself, this tumor usually does no harm, but can serve as the initial stage of an abscess - a severe purulent inflammation. The danger is that sometimes the pathology develops several years after the visit to the operating room, when the scar becomes inflamed. Therefore, it is necessary to know all the signs of such a disease and, at the slightest suspicion, consult a doctor. This will help to avoid new complications and additional surgical interventions.

Article for the site "Health Recipes" prepared by Nadezhda Zhukova.

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