1, superficial scar: more common in abrasions, formed by skin damage and infection. This kind of scar is slightly rough in appearance, sometimes with pigmentation or depigmentation, but it is soft locally and has no function, and generally does not need special treatment. Clinically, it is common in skin abrasions, superficial skin infections and superficial second-degree burns.
2. Atrophic scar: The appearance is mostly flat, even slightly lower than normal skin. The surface of atrophic scar is smooth and bright, hypopigmentation is white, and a few pigmentation areas are dark brown. Generally, it will not cause dysfunction. Facial excision, scar excision or local flap transfer can be used to improve the appearance. If scar excision and skin grafting are carried out, it is difficult to predict whether the skin color will change in the long term after skin grafting, so it should be used with caution.
3. The scar surface of concave scar is obviously lower than that of the surrounding normal skin, which is mostly caused by the wound healing of skin, subcutaneous tissue or deep tissue defects, and can also be caused by extensive tissue defects caused by severe purulent infection of skin and soft tissue. Treatment of concave scar: if the area is small, local tissue filling can be used for treatment. If it is a large short concave scar, and the scar can not be directly sutured, skin flap or myocutaneous flap surgery is needed to repair the deep tissue defects such as tendon, nerve and bone respectively, restore function and improve appearance.
4. Hypertrophic scar: Hypertrophic scar usually occurs in wounds with a depth of only dermis. The pathological difference between hypertrophic scar and normal scar lies in the thickening, irregular arrangement, or wavy or rope-like collagen fibers in the deep part of scar. The synthesis and metabolism of collagen continue to exceed the rate of catabolism, and a large number of collagen fibers are formed for a long time. The common causes are related to the existence of some local or systemic inducing factors. Local factors: foreign body, inflammation, talcum powder, cotton fiber, some chemicals on gloves when knotting and dressing changing. In addition, keratin isolated after cell destruction is also a local factor to stimulate scar hyperplasia. Systemic factors: pregnant women and hyperthyroidism patients are prone to hypertrophic scars, but hypertrophic scars are rare in the elderly.
5. Keloid: Keloid is a kind of scar characterized by continuous increase. It is also called crab's foot swelling, because it often shows a crab's foot-like image with good skin infiltration around it. Generally divided into two types: 1) tumor type; 2) infiltration type. The etiology is related to systemic factors. Specific physique, minor injuries, mosquito bites, vaccination and ear piercing can all form keloids. Local factors: such as foreign body, inflammation, local traction, etc. , are easy to induce proliferation tendency.
6, 蟎蟎: It looks like a duck 蟎, so it is called 蟎. Common in the inner and outer canthus, nasolabial groove, squabble, palm, tiger's mouth, nostrils, urethral orifice, vaginal orifice, perineum and other parts. The webbed scar at the joint makes the joint flex and contract, and the extension is limited, which affects the shape and function. Reticular scar is best corrected by "Z" plasty.
7. Bridge-shaped scar: Both ends of the scar are connected with the surrounding skin through pedicles, which is shaped like a bridge.
8, contracture scar and muscle fibroblasts. The proportion of myofibroblasts in scar increases and contracts, which leads to clinical symptoms. Timing of operation: Generally, premature delivery is not easy, and it should be performed after the scar is stable, mature and the basement is loose. Rescuing contracture is the key to successful operation. Early immobilization should be performed after operation to ensure that the transplanted skin or repaired tissue heals smoothly and the limbs are in functional position. Later, you should actively cooperate with functional exercise.