Non-operative treatment of hypertrophic scars and keloids after burns in children

Scars are a consequence of the natural way of wound healing and replacement of the damaged part of the skin. Hypertrophic scars and keloids are formed as a result of the process of abnormal wound healing, causing aesthetic and functional deformities, discomfort, and disturbance of children's normal growth. The prophylaxis and treatment of these scars, i.e. burns sequelae, are a significant moment in the treatment of children with burns. The objectives of the present study are methods for the prophylaxis and non-operative treatment of hypertrophic scars and keloids in children with burns. Altogether, 547 children with 485 burns sequelae - fresh scars in the period of healing and old hypertrophic scars (377) and keloids (108) - were treated in our Clinic of Children's Burns for a period of five years. The age of the patients varied between 0 and 18 years. Non-operative treatment was applied in 276 children. The patients were divided into two groups according to the treatment applied. Compression, intralesional application of triamcinolone acetonide, and silicone sheets were employed in the first group (84.06%), while only silicone sheets were applied to children in the second group (15.94%). Unaffected areas and areas adjacent to the scar were used as control areas. The sequelae monitored in both groups were assessed using the Vancouver Scar Scale. The children were monitored in an out-patient department. The results obtained are regardless of age, anatomical location, and scar aetiology. In old scars, and especially in keloids, the treatment proved to have variable results, according to the assessment parameters. We were satisfied with the improvement of the parameters during the course of treatment and with the good final results, which we consider a therapeutic success. Analysis of the results shows that the parameters improved slowly during the course of treatment, the process being most active during the first few weeks. The use of compressive therapy, the intralesional application of triamcinolone acetonide, and silicone sheets may prevent and minimize the formation of hypertrophic scars and keloids. The methods of non-operative treatment of these abnormal scars continue to be discussed and developed.