Yanıkta Skar Yönetimi
Özet
Hipertrofik skar ve keloid, özellikle derin yanıklar ve dermal hasarlanmalar sonrasında ortaya çıkan, patolojik olarak aşırı dermal fibrozis ile karakterize anormal yara iyileşmesi komplikasyonlarıdır. Estetik görünümü bozan bu yapılar; kaşıntı, ağrı ve hassasiyet gibi semptomlara yol açarak hastaların yaşam kalitesini, uyku düzenini ve psikolojik durumunu olumsuz yönde etkilemektedir. Genetik yatkınlık, yaş, cilt tipi, yaranın anatomik konumu, gerilimi ve iyileşme süresi skar gelişimini doğrudan etkileyen faktörler arasındadır. Yanık sonrası iyileşme sürecinin 21 günü aşması durumunda hipertrofik skar riski %78'e kadar yükselmekte, bu nedenle erken dönemde topikal tedavilere başlanması veya cerrahi eksizyon/greftleme gibi profilaktik yaklaşımların uygulanması kritik önem taşımaktadır. Skar yönetiminde evrensel ve tek bir standart protokol bulunmamakla birlikte; basınç tedavisi, silikon bazlı jeller, intralezyonel kortikosteroid (triamsinolon asetonid) ve florourasil (5-FU) enjeksiyonları, kriyoterapi, soğan özü uygulamaları ve fraksiyonel CO2 gibi çeşitli lazer teknolojileri aktif olarak kullanılmaktadır. Tedavi yaklaşımı; skarın matürasyon durumuna, boyutuna (minör veya majör keloid ayrımına) ve fonksiyonel kontraktür oluşturma riskine göre basamaklı olarak planlanmakta ve hastaların tedavi öncesinde nüks riskleri ile beklentileri hakkında detaylıca bilgilendirilmesi gerekmektedir.
Hypertrophic scars and keloids are abnormal wound healing complications characterized by pathologically excessive dermal fibrosis, emerging particularly after deep burns and dermal injuries. These structures, which impair aesthetic appearance, adversely affect patients' quality of life, sleep patterns, and psychological status by causing symptoms such as pruritus, pain, and tenderness. Genetic predisposition, age, skin type, anatomical location, tension, and healing duration of the wound are factors directly influencing scar development. If the healing process after a burn exceeds 21 days, the risk of hypertrophic scar development rises up to 78%, making the early initiation of topical treatments or prophylactic approaches such as surgical excision and grafting critically important. Although there is no universal single standard protocol in scar management, various laser technologies such as fractional CO2, pressure therapy, silicone-based gels, intralesional corticosteroid (triamcinolone acetonide) and fluorouracil (5-FU) injections, cryotherapy, and onion extract applications are actively utilized. The therapeutic approach is planned progressively based on the maturation status, size (differentiation between minor and major keloid), and the risk of developing functional contractures of the scar, and patients must be thoroughly informed about recurrence risks and expectations prior to treatment.
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