I had a major surgery 11 months ago to removed a tumor from my pancreas Two months after the surgery, I developed a thick and bulky scar. I went to the doctor and he told me it was a hypertrophic scar. I'm really sad and I feel very frustrated because I've heard that this condition sometimes doesn't respond well to treatment. My scar is approximately 14 cm. long and about 1/2 inch thick. I've been using silicone sheets for almost 8 months now without any luck, any other suggestions? Any advices will be appreciated. Thanks and God Bless You.
Options for Removing a Hypertrophic Scar?
Doctor Answers 6
Removing a hypertrophic scar
What you should understand is that a HYPERTROPHIC SCAR is going to improve. You do not treat this. A KELOIDAL scar, on the other hand is going to remain or get worse so we treat these with topical or intralesional steroids.
If you mistakenly inject a steroid into a hypertrophic scar you may end up with ATROPHY which you don't want.
From what you are describing this is a KELOID and as such should be treated by injections. Don't think silicone sheeting will get through this type of situation.
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Scar hypertrophy that developed after your pancreas surgery may be treated with steroid injections or even scar revision. Silicone sheeting like you are doing is also a good thing. I would wait another 6 months to see how the scar does. It is still maturing and may flatten and improve in color with time.
Hypertrophic Scar after surgery on the abdomen
It is most likely a scar that is caused by increased tension on the wound. In these cases, the most applicable treatment is scar revision with layered closure to improve tension free healing.
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Options for hypertrophic scar
Kenalog (cortisone), 5-Fluorouracil or a combination of the two injected at 4-week intervals as needed may be your best option to reduce the bulkiness of the scar (and any symptoms of itching or discomfort you might be experiencing).
If the scar is red or pink in color, certain vascular lasers can be beneficial (e.g. Pulsed dye laser).
Time and kenolog injection!
With time your scar will get better. Since it has been 11 months, it is ok to start some kenolog injection. This will help flatten the scar and make it less irritant. Best of luck!
Hyperplastic scar should shrink
The difference between a hyperplastic scar and a keloid is that in the former the collagen is laid down properly, ie. in the correct direction and with the needed consistency. However, the signal to turn off production is askue. This results in the scar being piled up too high, above 'skin level."
In a keloid the collagen not only rises above the skin, but the collagen is laid down in thick bands going every which way. The collagen is also more coarse.
A true hyperplastic scar should remold itself and flatten out given time. A keloid will not do this.
Thus, your hyperplastic scar should shrink and leave you with a normal scar. To hasten this process, you could return to your surgeon for steroid injections. I personally start out with 5 mg/cc but will go up to 10 mg/cc.
Freezing at the same time as the injection will ameliorate the pain and in addition help contract the scar. However, freezing in darker skin tones can damage melanocytes ( the cells which make pigment) leaving blanched areas.