Scar Revision Skin Cosmetic Surgery
Unsatisfactory
scars often can be improved by one of the revision procedures. Often revision
can be done within two or three months after the initial wound is incurred,
provided some characteristics of the scar such as its direction, shape or
severity of contraction, are amenable to improvement by revision techniques.
A linear scar is the inevitable consequence of all wound healing. In most
scars, there has been little or no tissue loss, such as in burns, traumatic
avulsions or surgical excisions. However, scars secondary to tissue loss
are generally wide, hyperthrophic and may require addition of skin in the
form of skin grafts or flap for improvement.
The simplest procedure for scar treatment is excision followed by direct
approximation of wound edges. However, wide scars can be made worse by repeated
excisions and resuturing of the skin edges when the fundamental defect is
a lack of tissue. In this case, addition of skin is needed.
A widely used scar revision method is z plasty. This means that the scar
is turned into a Z and two triangles are fromed. Than, the triangular flaps
are tranposed. With the use of Z plasty, the direction of the scar is changed,
the scar is divided into smaller segments running in zig zag pattern thus
diminishing the contractile pull of long straight scar. Also the relaxation
of tissue in the direction of the original scar guarantees the normal convexity
or concavity of the region.
A new method for improving scar is the covering of wound with silastic gel
sheeting. After the scar is excised, and sutures removed, a gel sheeting
is applied over the site for 3 to 6 months. No pressure is needed. However,
silastic gel sheeting is not effective on old scars. There are many papers
published about the beneficial clinical effects of the sheeting on scars
but the mechanism is not yet clearly understood.
In case of scars formed by tissue loss, additon of skin is needed. A choice
is a skin graft taken from the same patient. A skin graft is a part of the
skin containing epidermis and dermis, which is cut from the donor site by
dermatoms (special instrument to cut skin in desired thickness). However,
the cosmetic result of the grafts are not good. A color difference may occur.
Also skin grafts contract and some pigmentation may occur.
Another method for addition of skin is "skin expansion". This is accomplished
by silastic expanders. Expanders are balloon shaped materials with a reservoir
attached by a small tube to the main part. The reservoir is used to inject
saline to the main part. The injections are made once a week until the expander
is filled completely. This takes 2 to 3 months. In the second operation,
the expander is removed and the scar tissue is resected. The skin edges
are sutured with minimal tension with the aid of relaxed and expanded skin.
This method is also used to remove partial losses of hair. The scalp is
expanded and than then the skin without hair is resected and the skin edges
are approximated.
