Extramarginal excision is preferable for hypertrophic scars

Abstract

BACKGROUND: Recently, higher proliferative activity and collagen production in the peripheral parts of keloids have been reported. Therefore, we hypothesized that insufficient removal of active proliferating and collagen-producing fibroblasts at the scar margin might cause a high recurrence rate of hypertrophic scars and keloids. To address this hypothesis, we evaluated the influence of surgical margins on the recurrence of hypertrophic scars and compared the recurrence rates between intramarginal excision and extramarginal excision. METHODS: A retrospective review was performed of patients with car tire injury-induced hypertrophic scars treated by surgical excision from 2004 to 2010. To evaluate the influence of surgical margins on the recurrence of hypertrophic scars, we divided these patients into two groups, the intramarginal excision group and the extramarginal excision group, and compared the recurrence rate. RESULTS: A total of 15 patients with car tire injury-induced hypertrophic scars were treated with surgical excision and skin grafting. The recurrence rate in those with intramarginal excision was significantly higher than in those with extramarginal excision. All patients treated with intramarginal excision experienced hypertrophic scar recurrence within six months. Three of nine patients exhibited recurrence when the hypertrophic scars were excised with a 3-5 mm margin. CONCLUSION: Extramarginal excision with complete removal of the abnormal collagen bundles followed by skin grafting is a viable alternative to reconstruction of the foot after hypertrophic scar excision, and this treatment can effectively decrease issues related to recurrence.