On scars Aspects of treatment, pathophysiology and assessment

This thesis focuses on scars. It discusses various aspects of scars, including their assessment, pathophysiology and treatment options.
Scar evaluation tools are necessary for an evidence-based approach to scar management.
The Patient and Observer Scar Assessment Scale (POSAS), had been found to be useful in the subjective evaluation of burn scars. Now, we tested it on linear scars and it proved to be reliable and to have good internal consistency and intra-observer reliability.
The results of surgical excision and adjuvant irradiation for therapy-resistant keloids are evaluated and on the basis of the results we are reluctant to advocate the widespread use of surgical excision combined with immediate radiotherapy and think it should be preserved as a last resort in therapy-resistant keloids.
A number of rare congenital syndromes are reported to be associated with keloids.
We describe the appearance of keloids in the Rubinstein-Taybi Syndrome. RTS is caused by mutations in CREBB and EP300, both co-activators in the pathway that has been suggested to play a key role in keloid development. Also a group of 7 patients was found whose condition resembles the diagnosis of Frontometaphyseal Dysplasia (FMD) but without the FLNA mutations usually seen and with marked keloid formation.
In our search to make the most inconspicuous scar possible we compared the closure of median sternotomy incisions in children with regard to wound healing and scar formation by comparing subcuticular sutures with Steri-Strip^TMS. The last chapter is dedicated to the effect that age has on scar formation.