Background: Hypertrophic scar causes physical and psychological problems. Thus, understanding the factors related to the occurrence of hypertrophic scar tissue is needed. Little is known about its influencing factors in Indonesia, especially in Garut.
Objective: This study aims to examine the relationships between hypertrophic scar and its influencing factors, and identify the most dominant factor of the occurrence of hypertrophic scars.
Methods: This was an observational case control study using retrospective approach in Polyclinic of Surgery of Regional Public Hospital of dr. Slamet of Garut Regency. There were 40 samples recruited in this study by purposive sampling, which was divided to be case group (20 patients) and control group (20 patients). Data were collected using Stony Brook Scar Evaluation Scale by observation and documentation of the medical records of patients. Data were analyzed using logistic regression analysis.
Results: Findings indicated that there were significant relationships between the surgical wound infection (p = 0.02), family history (p = 0.026), and type of suture (p = 0.043) with the occurrence of hypertrophic scars. The most dominant factor on the occurrence of hypertrophic scars was type of suture, acid polyglactin 910. The variables that had no significant relationships with the occurrence of hypertrophic scar tissue were age (p = 0.34), area of surgical wound (p = 0.177), and smoking habit (p = 0.479).
Conclusion: There were significant relationships between infection of surgical wound, genetic history, the type of suture, and the occurrence of hypertrophic scar tissue. The most dominant factor that influenced the occurrence of hypertrophic scar tissue was the type of suture. Therefore, it is suggested to health professionals to modify the using of acid polyglactin 910 sutures, and nurses particularly need to provide the information regarding the family history and genetic-related hypertrophic scar, and prevent the infection of surgical wound after operation.
Copyright (c) 2017 Andri Nugraha, Rizal Chaidir, Urip Rahayu, Santi Rinjani
This work is licensed under a Creative Commons Attribution 4.0 International License.
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Sund B. New developments in wound care. London: PJB Publications; 2000;
Gauglitz GG, Korting HC, Pavicic T, et al. Hypertrophic scarring and keloids: pathomechanisms and current and emerging treatment strategies. Molecular Medicine. 2011;17(1-2):113-125.
Bloemen, Ulrich, Zuijlen V, et al. Prevention and curative management of hypertrophic scar formation. Burns. 2009;35: 436-475.
Baker R, Baiarda FU, Linge C, et al. Review Article Cutaneous scarring: A clinical review. Dermatology Research and Practice, 2009; 7.
Dunkin C, Pleat J, Gillespie P, et al. Scarring occurs at a critical depth of skin injury: precise measurement in a graduated dermal scratch in human volunteer. Plastic and Reconstructive Surgery. 2012;(119):1722-1732.
Monstrey S, Middelkoop E, Vranckx JJ, et al. Updated scar management practical guidelines: Non-invasive and invasive measures. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2014; 67:1017.
Van Loey N, Bremer M, Faber A, et al. Itching following burns: epidemiology and predictors. British Journal of Dermatology. 2008;158: 95-100.
Wolfram D, Tzakonvand A, Katzer HP. Hypertrophic scars and keloids review of their pathophysiology, risk factors, and therapeutic management. Dermatology Surgery. 2009.35:171–181.
Chuangsuwanich A, Jongjamfa K. The efficacy of combined herbal extracts gel preparation in the prevention of postsurgical hypertrophic scar formation. Dermatologic Therapy (Heidelb).2014;4: 187–195.
Brown J, Ollier W, Thomson W, et al. Positive association of HLA-DRB1*15 with keloid disease in Caucasians. International Journal of Immunogenetics. 2008;35: 303–307.
Aarabi S, Longaker MT, Gurtner GC. Hypertrophic scar formation following burns and trauma: New approaches to treatment. PLoS Medicine.2007;4(9): e234.
Mutalik S. Treatment of keloids and hypertrophic scars. Indian Journal of Dermatology, Venereology, and Leprology. 2005; 71(1):3-8.
Perdanasari AT, Lazzeri D, Su W, et al. Recent developments in the use of intralesional injections keloid treatment. Archives of Plastic Surgery. 2014; 41(6):620–629.
Broughton G, Rohrich RJ. Wound and scar. Selected Reading in Plastic Surgery. 2005;10(7):1-56.
Brown J, Bayat A. Genetic susceptibilityto raised dermal scarring. British Journal of Dermatol. 2009;161: 8–18.
Jucket G, Adam HH. Management of keloids and hypertrophic scars. American Family Physician. 2009; 80(3):253-260.
Al-Mubarak L, Al-Haddab M. cutaneous wound closure materials: an overview and update. Journal of Cutaneous and Aesthetic Surgery. 2013;6(4):178–188.
Wein R. Preoperative smoking cessation: impact on perioperative and long-term complications. Archives of Otolaryngology - Head and Neck Surgery. 2009; 135:597–601.
Zimmer T. Treatment of hypertrophic scars and keloids and the role of the nurse practitioner. Washington State University- Spokane, 2011:1-17.
Storch, Jill E. Reconstructive plastic surgical nursing: clinical management & wound care. Victoria: Blackwell Publishing Ltd; 2005.
Medical Record. Medical record of regional public hospital of dr. Slamet of Garut. Garut; 2015.
Ministry of Health of the Republic of Indonesia. Basic health research. Jakarta: Ministry of Health of the Republic of Indonesia; 2007.
Polit DF, Beck CT. Essentials of nursing research: Appraising evidence for nursing practice (7th ed.). Philadelphia: Wolters Kluwer Health, Lippincott Williams & Wilkins; 2010.
Singer AJAB, Dagum A, Valentine S, Hollander JE. Development and validation of a novel scar evaluation scale. Plastic and Reconstructive Surgery. 2007;120: 1892–1897.
Chenyu, Murphy, George, Satoshi, Rei. Keloids and hypertrophic scars: update and future directions. Plastic and Reconstructive Surgery. 2013;1(4): e25.
Shih B, Bayat A. Genetics of keloid scarring. Archives of Dermatology Research. 2010; 302:319-339.
Halim AS, Emami A, Salahshourifar I, et al. Keloid Scarring: Understanding the Genetic Basis, Advances, and Prospects. Archives of Plastic Surgery. 2012;39(3):184–189.
Son D, Harijan A. Overview of surgical scar prevention and management. Journal of Korean Medical Science. 2014;29(6): 751–757
Bitar GJ, Patel P, Craig L. Scar management. Aesthetic Medicine. 2011:277-288.
Enoch S, Leaper DJ. Basic science of wound healing. Surgery. 2005; 23(2):37-42.
Durkaya, tanoglu, Nadir, Yilmaz, Cinar, Dogan. Do absorbable sutures exacerbate presternal scarring? Texas Heart Institute Journal. 2005; 32:544-8.
Holzheimer. Adverse events of suture: possible interaction of biomaterial? European Journal of Medical Research. 2005; 10: 521-526.
Li-Tsang CW1, Lau JC, Chan CC. Prevalence of hypertrophic scar formation and its characteristics among the Chinese population. Burns. 2005;31(5):610-620.
Demetrius. Miminas. Ageing and its influence on wound healing. Wounds UK. 2007;3(1):5-20.
Delavary BM, Veer WMVD, Ferreira JA, etal. Formation of hypertrophic scars: Evolution and susceptibility. Journal of Plastic Surgery and Hand Surgery. 2012; 46:95–101.
Deliaert AEK, Kerckhove EVd, S T, Hul RRWJvd. Smoking and its effect on scar healing. European Journal of Plastic Surgery. 2012;3: 421–442.
Rayner R. Effects of Cigarette Smoking on Cutaneous Wound Healing. Primary Intention. 2006; 14(3):100-102.
Kudur MH, Pai SB, Sripathi H, Prabhu S. Sutures and suturing techniques in skin closure. Indian Journal of Dermatology, Venereology, and Leprology. 2009;75: 425-34.
Chellamani KP, Veerasubramanian D, Balaji RV. Surgical Sutures: An overview. Journal of Academia and Industrial Research.2013;1(12):778-782.
Tejani C, Sivitz AB, Rosen MD, et al. A comparison of cosmetic outcomes of lacerations on the extremities and trunk using absorbable versus nonabsorbable sutures. Academic Emergency Medicine. 2014; 21(6):637-43.