HYPERTROPHIC SCAR REVISION; KELOID REVISION; SCAR REPAIR
Definition
Surgical
procedure to improve or minimize the appearance of scars, restore function, and correct
disfigurement resulting from an injury, lesion, or previous surgery.
Description
Scar tissue
forms as skin heals after an injury (such as an accident) or surgery. The amount of
scarring may be determined by the size, depth, and location of the wound; the age of the
person; heredity; and skin characteristics including color (pigmentation).
Surgery to revise scars is done while the patient is awake, sleeping (sedated), or deep
asleep and pain-free (local anesthesia or general anesthesia).
Medications (topical corticosteroids, anesthetic ointments, and antihistamine creams) can
reduce the symptoms of itching and tenderness. Scars shrink and becomes less noticeable as
they age, therefore, immediate surgical revision is delayed until the scar lightens in
color, which is usually several months or even a year after a wound has healed.
A keloid is an abnormal scar that is thicker, different color and texture, extends beyond
the edge of the wound, and has a tendency to recur. It often creates a thick, puckered
effect simulating a tumor. Keloids are removed at the point where it meets normal tissue.
Massive injuries (such as burns) can cause loss of a large area of skin and may form
hypertrophic scars. A hypertrophic scar can cause restricted movement of muscles, joints,
and tendons (contracture). Surgical repair includes removing excessive scar tissue and a
series of small incisions on both sides of the scar site, which create V-shaped skin flaps
(Z-plasty) may be used. The result is a thin, less noticeable scar because the wound
closure following a Z-plasty more closely follows the natural skin folds.
Skin grafting involves the taking a thin (split thickness) layer of skin from another part
of the body and placing it over the injured area. Skin flap surgery involves moving an
entire thickness (full thickness) of skin, fat, nerves, blood vessels, and muscle from a
healthy part of the body to the injured site. These techniques are planned when a
considerable amount of skin has been lost in the original injury, when a thin scar will
not heal, and when improved function (rather than aesthetic reasons) are the primary
concern. Secondary procedures may later be necessary to achieve appropriate aesthetic
results.
Indications
No scar can be
removed completely. The degree of improvement will depend on variables such as the
direction and size of the scar, the age of the person, skin type and color, and hereditary
factors that may precondition the extent of the healing process.
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