Scar Management

A 24-year-old woman presents four months after thyroid surgery with a raised, red, pruritic scar confined to the original incision. The scar is firm but has not extended beyond the wound edges. There is no drainage or infection. What is the most appropriate initial management?

A 29-year-old man develops a progressively enlarging firm scar on the anterior chest after removal of a small skin lesion. The scar extends well beyond the original incision and is painful and itchy. What is the most likely diagnosis?

A 32-year-old woman has a symptomatic earlobe keloid that recurred after previous excision alone. The lesion is firm, pruritic, and extends beyond the original piercing site. What is the most appropriate treatment strategy?

A 35-year-old man has a thick, painful hypertrophic scar across the shoulder six months after a burn. Silicone therapy and massage have produced little improvement. The scar remains raised, erythematous, and intensely pruritic. What is the most appropriate next treatment?

A 27-year-old woman receives repeated intralesional corticosteroid injections for a presternal keloid. The scar becomes flatter, but the surrounding skin develops thinning, visible small vessels, and lighter pigmentation. What is the most likely cause?

A 38-year-old woman presents one year after a deep burn to the anterior neck. She has a mature scar band that pulls the chin downward, limits neck extension, and causes difficulty maintaining oral competence. What is the most appropriate definitive management?

A 26-year-old man has a mature linear scar crossing the antecubital fossa. The scar is narrow but restricts full elbow extension because it lies perpendicular to the flexion crease. Surrounding skin is healthy and lax. What is the most appropriate surgical correction?

A 41-year-old woman presents two months after facial laceration repair with a red, firm scar that is still evolving. The wound is fully healed, the scar is not causing distortion, and there is no infection. She requests immediate surgical revision because of its appearance. What is the most appropriate management?

A 30-year-old woman has a flat but intensely erythematous facial scar six months after trauma. The scar is soft, nonhypertrophic, and does not restrict movement. She has used silicone and sun protection without sufficient improvement. What is the most appropriate procedural treatment?

A 48-year-old man has a longstanding burn scar on the lower leg that recently developed an ulcer with raised everted edges, bleeding, and progressive enlargement. The area has not healed despite appropriate dressings. What is the most appropriate next management step?

A 22-year-old man is three weeks after complete healing of a deep partial-thickness burn to the upper arm. The healed area is becoming firm, raised, pruritic, and erythematous. There is no open wound or infection. What is the most appropriate next management step?

A 34-year-old woman has a broad, flat, widened abdominal scar one year after surgery. The scar is soft and asymptomatic, with no extension beyond the original incision. Examination shows that the scar lies under significant transverse tension, but there is enough surrounding skin for closure. What is the most appropriate surgical management?

A 28-year-old man has a recurrent presternal keloid that remains thick and painful despite several intralesional corticosteroid injections. The lesion has not ulcerated, and the surrounding skin is healthy. What is the most appropriate next nonsurgical treatment?

A 45-year-old woman has a mature depressed scar on the cheek after drainage of an abscess. The scar is tethered to the underlying fascia and becomes more visible during facial movement. The skin surface is otherwise healthy. What is the most appropriate corrective treatment?

A 39-year-old man presents after a hand burn with a mature first-web-space scar contracture that limits thumb abduction and interferes with grasp. The surrounding dorsal hand skin is supple, and no tendon or joint release is required. What is the most appropriate reconstruction?

A 31-year-old woman has a hypertrophic scar across the upper chest that remains raised and pruritic after silicone therapy and corticosteroid injections. The scar is highly erythematous and vascular but remains confined to the original incision. What is the most appropriate additional treatment?

A 52-year-old man has a mature burn scar contracture of the lower eyelid causing ectropion, tearing, and corneal exposure. The anterior lamella is shortened, while the posterior lamella remains intact. What is the most appropriate definitive management?

A 36-year-old woman has a painful linear scar after forearm surgery. Palpation over one point causes an electric-shock sensation radiating into the hand. The scar is flat and mature, and there is no infection or tendon limitation. What is the most appropriate next diagnostic step?

A 33-year-old man presents eight months after a laceration repair with a mature facial scar that is narrow but crosses relaxed skin-tension lines at an unfavorable angle, making it conspicuous. There is no hypertrophy, depression, or functional limitation. What is the most appropriate revision technique?

A 44-year-old woman undergoes excision of a mature burn contracture from the axilla. The released defect is broad, and shoulder abduction produces substantial tension. Local tissue is scarred and insufficient. What is the most appropriate reconstructive option?

A 30-year-old woman has a recurrent painful earlobe keloid after two previous excisions and multiple intralesional corticosteroid injections. The lesion continues to enlarge beyond the original piercing site. She understands the potential risks of additional treatment. What is the most appropriate management?

A 37-year-old man presents 18 months after a facial burn with a mature, flat scar that has marked surface irregularity and textural mismatch. The scar is soft, nonerythematous, and causes no functional restriction. What is the most appropriate procedural treatment?

A 43-year-old woman has a mature transverse suprapubic scar that is painful during movement and repeatedly becomes inflamed at one point. Examination shows a small draining sinus with a palpable firm focus beneath the scar. What is the most appropriate next management step?

A 40-year-old man presents one year after a deep burn with a circumferential scar contracture around the wrist. He has progressive restriction of wrist extension, compression symptoms in the hand, and inadequate adjacent healthy skin for local rearrangement. What is the most appropriate definitive reconstruction?