Keloid and Hypertrophic Scar Assessment
Clinical characteristics separate hypertrophic and keloid scars from normal scars. Both hypertrophic and keloid scars are distinct entities from each other as well. Being able to identify what type of scar is present in the clinical setting allows for a more precise treatment plan. The area most susceptible to abnormal scarring within orthopedics is the neck. Although the anterior chest is most common for keloid formation, it is less applicable to this current review. Other areas of concern include the pretibial skin, the posterior shoulder, and across joints. Although ear keloids are most common in the cohort as a whole, they are a distinct entity that does not predict keloid formation in other body areas. The patient's own perception of the cosmesis of their scar, pain, and pruritus should all be considered in management.

When assessing a post-surgical wound, several factors must be considered. The Vancouver Scar Scale is a validated tool for scar assessment and assesses for pigmentation, vascularity, height, and pliability. It can be a useful tool for prognosis and treatment requirements. Although very specific in nature, its utility is limited clinically. The Vancouver Scar Scale focuses on burn scars and is often more applicable in the research setting. Table 1 above demonstrates several clinical and developmental features of the various scar types.

Hypertrophic scars are also pathologic in nature. They remain contained to the wound boundaries and grow abnormally thickened. They are red, sometimes painful, and can cause mild irritation to the skin. One study states this discomfort results from proinflammatory substance P released from nerve endings after the trauma or surgical insult. They can form as a result of excess tension, demonstrating the importance of a tension-free closure. They are more common at flexion surfaces on the extremities. They fade with time and flatten over the year after the insult to the dermis.