Procedures
Scar | Scar Revision
Scar revision
Any disturbance of skin integrity results in scarring. Scars are the inevitable consequence of open injuries, deep burns, some skin infections, or surgical procedures. They can be more or less visible, with or without functional interferences. Liability to scarring varies from one person to another. Certain regions of the body carry higher risks of conspicuous or hypertrophic scars.
BEFORE THE SURGERY:
Scar revision is required for esthetic or functional reasons. It should be said that there is no operation technique for their thorough elimination. Scars take a long maturation period, ranging from several months to one year, and therefore their revision should be postponed till the completion of that process. Exceptionally, some scars can be treated before this period for functional reasons (eyelid burns, finger contractures etc.). In patients liable to keloid scarring, there is a permanent risk of possible recurrences after the operation, despite additional measures of prevention, such as corticosteroid ointments or injections, compressive bandages and radiation.
DURING THE SURGERY:
In plastic surgery, there are several techniques of scar revision. The simplest procedure involves scar excision followed by approximation of the wound edges. It is applied in cases when there is a sufficient quantity of surrounding tissue. In the recent time, special self-sticking silicone gel sheets to cover the wound upon the suture removal have also been available. These sheets are applied during 3 to 6 months. However, they have proved ineffective in the treatment of old scars. In the scars that retract the surrounding tissue, thus causing functional disturbances, the so-called Z plastic is most commonly used. Its aim is to alter the scar direction and decrease the retracting force.
Scars associated with the loss of tissue are characterized by the lack of skin coverage. A choice technique in such cases may involve transplantation of the patient’s own skin. However, the results can often prove unsatisfactory due to pigmentation changes on the transplanted skin. A more severe skin insufficiency may require the skin expansion technique. This involves the insertion of a silicone balloon into the healthy tissue close to the scar. The balloon is gradually enlarged by periodical injections of physiological solution. When the skin is sufficiently expanded, the balloon is removed, the scar is cut out and the excision covered by the expanded skin.
AFTER THE SURGERY:
Fresh scars should not be exposed to the sun for several months. A variety of products on the basis of ointment or gel can be used to decrease the scars visibility, although it should be said that their effects are often unreliable.
