Methods described for treatment of keloid and hypertrophic
scars include local corticosteroid injection,
pulsed dye lamp treatment, use of silicone gels and excision
of the scar. Currently there is no evidence on
superiority of one particular modality [5-8].
In this case report non-invasive management options
were initially pursued (silicone elastomer sheeting) due
to their relative ease of use and low risk of adverse
effects. Although the exact mechanisms of action are
unknown, there have been reports of acceptable results
[9]. Application of a pressure dressing after surgical
excision was used on this patient because simple surgical
excision without use of adjuncts is commonly followed
by recurrence [10].
Mofikyo et al. were unable to identify a single, reliable
and effective protocol regarding management. They
reported that surgical excision with post-operative
topical steroid injection had low recurrence rates [11].
Sternotomy incisions are relatively immobile and skin
closure is free from tension. The usual suture material
for skin closure in our unit is monofilament polymer
(Monocryl™). There is some evidence that it produces
significantly smaller and less reactive scars than other
suture materials such as Vicryl-rapide [12].
Durkaya et al. found that the lower half of the wound
was more susceptible to scarring regardless of the suture
material used, but the upper part was more susceptible
to hypertrophy with the use of absorbable sutures [13].
Overall the risk of scar hypertrophy is less with the use
of monofilament sutures when compared with absorbable
sutures. The relative mobility and increased tension
over the xiphoid process was felt to yield a less satisfactory
result.