Optimization of therapeutic and preventive tactics for scar defects after breast surgery

Abstract

The aim of the work: to improve a complex treatment of patients with scar defects on the breast after surgical interventions and to substantiate the differentiated approach to the choice of therapeutic and prophylactic algorithm depending on the pathogenesis of the defective scar formation of morphology.

Materials and Methods. The results of therapeutic and prophylactic measures in three groups of patients were studied: in the group 1 (n=40), the infiltration of the scar was performed with a solution of corticosteroid and lidocaine along with Mepiform (Sweden) silicone patch and compression therapy application; in the group 2 (n=53), a surgical excision was performed followed by the introduction of diprospanone into the subcutaneous zone and the use of the silicone patch; in the group 3 (control, n=45), an excision was only performed without the prevention of the scar defect recurrence. With ultrasonic dermascanning in dynamics, the size, volume and acoustic scan density were measured. Acoustic density measurements of the dermis was carried out in the area of ​​the scar location; as a control, the acoustic density of the dermis on a healthy contralateral area of ​​the skin was measured. For scars less than 2 mm in width (ultrasonographic evaluation), a conservative therapy was used (patients of group І). Control ultrasound examinations were carried out in 1, 3, 9 and 12 months after the stitches were removed. Morphological and immunohistochemical study of the removed scars was carried out.

Results and Discussion. Due to the combined use of glucocorticoids, compression bandages and silicone patches, in the first study group, a decrease in collagenogenesis, capillary degeneration and, consequently, prevention of the scar defect recurrence were achieved. In 9–12 months, the normotrophic scars were observed in 67.5 %, hypotrophic – in 32.5 %. However, in the group 2, keloid scars were detected in 28.9 % of cases, hypertrophic – in 20 %, hypotrophic – in 11.1 %, normotrophic – in 40 %. The obtained data confirm that surgical excision, as an additional mechanical trauma, does not provide an ideal solution for the elimination of defective scar, even in combination with preventive measures. The above statement can also be concluded from the results of the control group treatment (scar excision only): keloid scars in 46.7 %, hypertrophic – in 11.1 %, normotrophic – in 40 %.