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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