Chronic scar tenderness Discussion

Chronic scar tenderness may be a difficult and possibly incapacitating problem after an extremity wound has healed. This may be due to a number of problems, including local nerve irritation or neuroma, chronic reaction to retained foreign debris, chronic low grade infection, failure of a fracture to heal, poor blood supply, flare of Dupuytren's disease, dysesthesia or sympathetic dystrophy, others or a combination of these factors. The patient may develop compensatory abnormal positioning or posturing of the extremity to avoid triggering painful symptoms during use, which may lead to myofascial symptoms elsewhere. Treatment options must be individualized, but in general include evaluation for specific problems noted above and a therapy program of desensitization. Patient participation in therapy is key to recovery, and noncompliance is a contraindication to treatment. In some cases, replacing the tender scar with a flap, followed by additional therapy is recommended. Recovery is unpredictable, and some patients fail to improve despite thorough and aggressive treatment.

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