A new article published in The Journal of the American Academy of Orthopedic Surgeons discussed that keloid and hypertrophic scar formation after orthopedic surgical closure is a complex issue. The nature and location of procedures maximize wound tension, leave foreign bodies and diminish dermal supply, all potentiating keloid formation.

This standard review of abnormal scarring in orthopedic surgerystated that there is little discussion regarding the pathophysiology and management of this recurrent problem in orthopedic literature. Keloid formation is a fibroproliferative disorder resulting in extensive production of extracellular matrix and collagen, but its prevention and treatment is poorly understood.

The authors stated that the treatments include both medical and surgical therapies that work at a biologic level and attempt to produce a cosmetic and complication-free management strategy. Medical options that have been investigated include combinations of intralesional steroid therapy, laser therapyand biologics. While preventive surgical closure and excision remain mainstays of treatment, radiation therapy has also been used in refractory cases with mixed results.

Moreover, despite medical therapies and surgical excision aimed at treating the resulting scar, recurrence rate is very high for all modalities that have been studied to this point. This article concluded that futureresearch is focused at better understanding the pathophysiology leading to keloid and hypertrophic scar formation—in an effort to find preventive methods as compared to treatment strategies.

Source: The Journal of the American Academy of Orthopedic Surgeons. 2020 May 15;28(10):e408-e414.doi: 10.5435/JAAOS-D-19-00690.