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Dear Editor:
  In the April 2012 Evidence Corner (WOUNDS. 2012;24(4):A10,12–13) my friend and colleague, Dr. Laura Bolton, writes about certain therapies that may or may not work for different types of scars.

  Dr. Bolton quotes an article by Pai and Cummings on sternotomy scars and their treatment (Pai VB, Cummings I. Are there any good treatments for keloid scarring after sternotomy? Interact Cardiovasc Thorac Surg. 2011;13(4):415–418). However, in their article, Pai and Cummings put treatment of hypertrophic and keloid scars under one umbrella. This is a serious mistake since these two types of scars are very different from a histological, genetic, and cosmetic point of view.

As an example: one of the reasons why hypertrophy occurs so often after a sternotomy, as the article mentions, is indeed tension on the wound edges. Keloid often occurs on the ear (after perforation for earrings), an area without any tension on an incision/perforation. Consequently, successful treatment of one type of scar cannot be extrapolated to the other one without actually being tried and proven.

  An additional comment on the article by Verhaegen et al (Verhaegen PD, van der Wal MB, Bloemen MC, et al. Sustainable effect of skin stretching for burn scar excision: long-term results of a multicenter randomized controlled trial. Burns. 2011;37(7):1222–1228.) covered in the same Evidence Corner—a Z- or W-plasty is often used in burn care, not to treat a hypertrophic scar itself, but to reduce tension of a contracture (usually over a joint, by releasing the contracture itself) to lower the tension on an adjacent hypertrophic scar.

Michel H.E. Hermans, MD
Hermans Consulting, Inc.
Newtown, PA