Discussion On The Treatment Of Lower Abdominal Keloids Caused By Longitudinal Cesarean Section Incision

Background:Keloid is a kind of pathological scar,which belongs to dermal fibrosis and is the result of abnormal repair of skin connective tissue after trauma.Patients with keloids will suffer physical and mental torture due to itching,pain and even functional impairment caused by scar contracture,which seriously affects people’s quality of life.In order to reduce deep tissue damage during cesarean section,doctors sometimes make longitudinal incisions,resulting in a long linear scar after the patient’s abdomen.Clinically,we found that longitudinal abdominal incisions are more prone to hyperplasia,and larger keloids will form above the pubic region.Keloid scars in this location are difficult to treat and prone to recurrence,possibly due to the greater vertical continuous tension caused by the linear contracture of the longer longitudinal scar.Therefore,when we try to treat long linear keloids caused by longitudinal incision after cesarean section,we hope to break the linear shape of linear keloids by adjusting the direction of tension,and turn straight lines into curves to reduce tension,and combine radiation therapy to treat keloids in this area to reduce the chance of keloid recurrence and complications from linear contractures.Objective:Interruption of continuous longitudinal tension by changing the direction of the keloid,reducing tension through incision tension sutures,and combining radiation therapy to reduce the recurrence of such keloid scars and the chance of complications from linear contractures.Methods:This study included 12 patients with keloid formation in the pubic region after longitudinal incision cesarean section treated in the Plastic and Aesthetic Surgery Department of the First Hospital of Jilin University from March 2019 to March 2021,with a mean age of 35.5 years（range 27-43 years old）,the keloid size ranged from 3cm×7cm-13cm×6cm.All study patients received the following treatments: surgical complete excision of the scar,Z-flap repair（reversing tension direction）,subcutaneous anchoring（preventing dead space and hematoma,and promoting flap survival）,skin tension-reducing sutures（lowering the incisal margins’ tension）,medical sutures and buckles to fix tension reduction and postoperative radiation therapy（reduce recurrence rate）,postoperative abdominal girdle compression for at least one month.Regular follow-up was followed up for 24 months after surgery to compare the treatment effects and use the Manchester Scar Scale to score.Results:Of the 12 patients,only 2 patients（16.7%）had a mild recurrence at 6months postoperatively,with good results after re-irradiation with radiotherapy.Other cases（83.3%）had smooth postoperative course without recurrence.Two patients developed superficial skin ulceration after radiotherapy,which healed after dressing change.The average score of all patients measured by the Manchester Scar Rating Scale was 14.83 before treatment and 6.92 after treatment.There was a significant difference in scores before and after treatment（p<0.05）.The patient’s subjective symptoms improved significantly.Conclusions:（1）Through the design of the skin flap,the long continuous longitudinal scar is broken,and the tension direction is an effective method to treat the keloid caused by the longitudinal cesarean section incision.（2）Intraoperative wide separation can reduce tension.Tension-reducing suture technique and subcutaneous anchoring in some parts can effectively reduce the occurrence of hematoma,promote the survival of the skin flap,and effectively avoid the recurrence of keloids.