When preventing hypertrophic scars after a surgical excision, I understand that 5-FU injections and the application of pressure during the initial acute healing period are among the various treatments available.
However, I have read that 5-FU injections should not be simultaneously combined with exerting pressure on the wound site, such as wearing a pressure garment. Is this true? If yes, what is the reason?
This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon.
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Fluorouracil or 5-FU is an anticancer medication, the topical version has been used for superficial cancers has a bad habit of leaving deeper cancer behind, so I never liked it for my own patients. It had a slightly better effect for pre-malignant lesions, but the skin reaction for the topical cream was bad to horrible. I never used it for Scar Care
, even when treating Keloids or patients with tendency to form bad scars. I did use After Surgery Compression Garments
for both early after surgery such as this Stage 1 Compression Vest
and then Stage Two Compression Vest
for the improvement I saw in the scars prevention over those who were not using the longer term pressure.
When you look at Invited Discussion: 5-Fluorouracil Treatment of Problematic Scars
and see "success" recurrence rates of only 19%" or "50% median decrease in scar." That type of study had been enough to frighten me off from using that option. That was not sufficient for my use in my patients. Fluorouracil Treatment of Problematic Scars – an Article Review
had this conclusion:
I find this article interesting, but am not ready to begin using 5-fluorouracil prior to the tradition treatment courses. As the authors point out,
So you would have to ask someone who is using that as part of their treatment plan. For what types of scars are they using this medication? What concentrations? How applied? And for what reasons? How long of a follow up did they document their success?
Some prefer to separate their treatments for various reasons. One might be that patient is part of a study and the variables need to be limited. Another, if the medication does cause a horrible skin reaction as seen in the cancer use, then added pressure may be enough to endanger the tissue enough beyond survival to increase complication rates like wounds, loss tissue, and such.
I did try to conquer keloid scars early in my career until I realized the wise saying of one of my early mentors: Griffith, B Herold M.D. who said: each new generation thinks they have discovered the cure or treatment of a keloid, only over time to be proven wrong. I tried many different methods, only to realize that I too had not found a way. My practice further specialized and moved on as patients were coming to me from around the world for other aspects of my techniques. I focused instead on scar prevention instead. When I found a patient had a bad tendency to keloid formation, that, made elective surgery for subtle issues something I did not offer.
Why not ask the doctor recommending the treatment options and post the answers here?
Are you trying to treat a keloid or prevent one having a tendency to forming them?
Hope this helps,
Michael Bermant, MDLearn More About Plastic Surgery