Background and objective.

The keloid scar is one of the most frustrating clinical problems in wound healing and a great challenge for doctors. The various treatments (partial or total excision), intralesional drug injection, radiotherapy, laser, silicone, lycra garments, among others, have a high risk of recurrence (10-45%).

The challenges facing the rehabilitation community include the investigation of the healing process, the effects of the different factors involved in wound healing and the development of scars, and the best combination of surgical, pharmacological and therapeutic interventions to maximize the result. Surgery can be performed to treat keloids in two ways: first, radical resection of keloids and, secondly, reduction of keloid mass.

Our general objective is to improve hypertrophic and keloid scars with multiple zetaplasties or with partial resection plus multiple zetaplasties.

Methods.

A prospective study was conducted on 335 scars classified based on the Vancouver scale between February 2013 and July 2018. Linear scars were intervened with multiple zetaplasty taking into account the lines of least tension; in hypertrophic scars or extensive keoids, if the neighboring tissue allowed it, the scar was partially resected, and perform multiple zetaplasty; if the neighboring tissue did not allow resection, some areas were selected to perform the first zetaplasty session and in subsequent interventions the others were performed to be able to intervene the entire area based on the tension forces.

Results.

A total of 335 scars, 188 (56.1%) hypetrophic and 147 (43.9%) keloyds, were treated in patients between 1 and 56 years, for an average of 13 years. Face and neck 123 (37%), upper extremities 85 (25.3%), lower extremities 63 (18.8%), thorax 53 (15.8%) and ear 11 (3.3%) were the main areas treated. Of 123 intraopoeratory photographs reviewed, 4 (3%) had only one zetaplasty, 3 (2.4%) had 2 zetaplasties, 27 (21.9%) had 3 zetaplasties and 89 (72.3%) had more than 4 multiple zetaplasties (with one average of 6). With the good results obtained, surgery was also performed on patients with scars during the maturation process as soon as 3 or 4 months post burn. Seventy eight patients (23.2%) who have 5-year follow-up do not present recurrence nor 35 (10.4%) at 4 years.

Conclusions.

Multiple zetaplasty, with or without partial resection of hypertorphic scar o keloyd, can be performed on immature active scars, breaking the paradigm of waiting until the scar is mature or even when therapeutic treatments have failed. The continuous suture with monofilament is a technical contribution that allows to reduce surgical time and facilitates the removal of the stitches.

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