Scar Revision
Scar Revision — While no scar can be removed completely, scar revision can improve the appearance of the scar by making it less obvious. There are several variables that affect the severity of a scar including the depth and size of the wound, the area’s blood supply, the thickness and color of the skin, the direction of the scar, and each individual’s healing response.
Contractures are scars that have appeared when a large area of skin has been lost and the edges have been pulled together. In order to correct a contracture, the scar is usually removed, and a skin graft or flap is put in place. In some cases, a Z-plasty or tissue expansion is performed.
Facial scars are most commonly treated by cutting out the original scar, and closing the area with tiny stitches, leaving a thinner, and less noticeable scar. Dermabrasion is also common and done by scraping the top layers of skin using a hand-held, high-speed rotary wheel. Z-plasty also yields positive results for facial scars. Laser treatment can also be used to decrease scar discoloration.
Hypertrophic scars are thick, red, and raised in appearance, and are located within the boundaries of the incision or wound. Typically these scars improve with time, or with the help of steroid applications or injections. If surgical treatment is necessary, the excess scar tissue is removed and the incision is repositioned so it will heal in an inconspicuous pattern.
Keloid scars are thick, puckered, and itchy clusters of scar tissue. These scars are located at the edge of the wound or incision. These scars occur when the body continues to produce collagen once the wound has healed. Keloids are often treated using an injection of steroid medication to reduce redness, itching, and burning. It may also shrink the scar. The scar tissue can be excised, and the wound closed with one or more layers of stitches. Often steroid applications or injections, and radiation therapy are necessary and used in conjunction with scar removal to reduce the likelihood that the keloid reappears.
Additional Techniques
Flap surgery is a more complex procedure that involves separating the skin, along with the underlying fat, blood vessels, and sometimes muscles, and moving it from a healthy area to the site of injury. In some cases, the flap’s blood supply remains attached at one end to the donor site, while in other cases, the blood vessels are reattached to vessels in the injured area using microvascular surgery.
Skin grafting involves transferring skin from a healthy area to the injured area. Grafting is successful once new blood vessels and scar tissue from the injured area grow into the graft.
Z-plasty is a surgical technique that is used to reposition a scar along the natural lines and creases of the skin. The old scar is removed and new incisions are made to produce triangle flaps of skin. These flaps are then rearranged to cover the wound at different angles, giving the scar a "Z" pattern. This allows the wound to heal with less tension.