Scar Revision Surgery

Description  ( Overview)

Scar revision surgery refers to a group of procedures that are done to partially remove scar tissue following surgery or injury, or to make the scar(s) less noticeable. The specific procedure that is performed depends on the type of scar; its cause, location, and size; and the characteristics of the patient’s skin.

Why  Scar Revision Surgery  Is  Reguired ?

Scar revision surgery is performed to improve the appearance of the patient’s face or other body part, but it is also done to restore or improve functioning when the formation of a scar interferes with the movement of muscles and joints. The shortening or tightening of the skin and underlying muscles that may accompany scar formation is known as contracture. Contractures may interfere with range of motion and other aspects of joint functioning, as well as deform the shape of the hand or other body part. Contractures in the face often affect the muscles that control facial expressions. Scar revision surgery may be considered as either a cosmetic procedure or a reconstructive surgery, depending on whether the patient’s concern is primarily related to appearance or whether contractures have also affected functioning.

Why  Iran Is Suitable For  Scar Revision Surgery ?

Patient Eligibility \ Who Can Have  Scar Revision Surgery  ?    

Good candidates for scar revision surgery are people who have a realistic understanding of its risks as well as its benefits, and equally realistic expectations of its potential outcomes.

Scar revision can be performed on people of any age and is a good option for you if:

• You are bothered by a scar anywhere on your body
• You are physically healthy
• You do not smoke
• You have a positive outlook and realistic goals for your scar revision surgery
• You do not have active acne or other skin diseases in the area to be treated

How Is  Scar Revision Surgery Done? (Procedures)

Most plastic surgeons use a variety of nonsurgical and surgical approaches to improve the appearance of scars. In addition, patients might need several different surgical procedures if their scar revisions require a series of operations at different stages of the healing process.

SURGICAL EXCISION. Surgical excision is a procedure in which the surgeon shaves down and cuts out scar tissue to reduce the size of the scar. This technique is most commonly used on large scars that cannot be treated adequately with medications or other nonsurgical means. When excision is done in stages, it is referred to as “serial excision.” This is performed if the area of the scar is too large to remove at one time without distorting nearby skin.

FLAPS, GRAFTS, AND ARTIFICIAL SKIN. Flaps, grafts, and artificial skin are used to treat contractures and large areas of scarring resulting from burns and other traumatic injuries. When there is not enough skin at the site of the injury to cover an incision made to remove scar tissue, the surgeon implants a skin graft or flap after cutting out the scar tissue itself. Skin grafts are thin layers of skin that are removed from another part of the patient’s body and carefully matched to the color and texture of the face or other area where the graft is to be placed. A skin flap is a full-thickness piece of tissue with its own blood supply that is taken from a site as close as possible to the scarred area.

Z-PLASTY AND W-PLASTY. Z-plasty and W-plasty are surgical techniques used to treat contractures and to minimize the visibility of scars by repositioning them along the natural lines and creases in the patient’s skin. They are not usually used to treat keloids or hypertrophic scars. In Z-plasty, the surgeon makes a Z-shaped incision with the middle line of the Z running along the scar tissue. The flaps of skin formed by the other lines of the Z are rotated and sewn into a new position that reorients the scar about 90 degrees. In effect, the Z-plasty minimizes the appearance of the scar by breaking up the straight line of the scar into smaller units.

A W-plasty is similar to a Z-plasty in that the goal of the procedure is to minimize the visibility of a scar by turning a straight line into an irregular one

LASER SKIN RESURFACING AND DERMABRASION. Skin resurfacing and dermabrasion are techniques used to treat acne scars or to smooth down scars with raised or uneven surfaces. They are known as ablative skin treatments because they remove the top layer of skin, or the epidermis. In dermabrasion, the surgeon moves an instrument with a high-speed rotating wheel over the scar tissue and surrounding skin several times in order to smooth the skin surface down to the lowest level of scarring. Laser skin resurfacing involves the use of a carbon dioxide or Er:YAG laser to evaporate the top layer of skin and tighten the underlying layer. Keloid or hypertrophic scars are treated with a pulsed dye laser. Dermabrasion or laser resurfacing can be used about five weeks after a scar excision to make the remaining scar less noticeable.

Preparation & Recovery

Prior to scar revision surgery, you may be asked to:

• Get lab testing or a medical evaluation
• Take certain medications or adjust your current medications
• Stop smoking well in advance of surgery
• Avoid taking aspirin and certain anti-inflammatory drugs and herbal supplements as they can increase bleeding

Aftercare following Z-plasty or surgical removal of a scar is relatively uncomplicated. The patient is given pain medication, told to rest for a day or two at home, and advised to avoid any activities that might put tension or pressure on the new incision(s). Most patients can return to work on the third day after surgery. The most important aspect of long-term aftercare is protecting the affected area from the sun because the surgical scar will take about a year to mature and is only about 80% as strong as undamaged skin. Sunlight can cause burns, permanent redness, loss of pigment in the skin, and breakdown of the collagen that maintains the elasticity of the skin.

Aftercare following the use of skin grafts, flaps, or dermal regeneration templates begins in the hospital with standard postoperative patients care. If sutures have been used, they are usually removed three to four days after surgery on the face and five to seven days after surgery for incisions elsewhere on the body.  If artificial skin has been used, the patients must keep the site absolutely dry, which may require special precautions or restrictions on bathing or showering.

Other Options

There are a number of nonsurgical treatments that can be used before, after, or in place of scar revision surgery.

Drugs

Medications may be used during the initial inflammatory phase of scar formation, as well as therapy for such specific skin disorders as acne. Keloids are often treated by direct injections of corticosteroids to reduce itching, redness, and burning; steroid treatment may also cause the keloid to shrink. Corticosteroid injections, gels, or tapes impregnated with medication are also used after scar excisions and Z-plasty to prevent recurrence or formation of hypertrophic scars. Acne scars are treated with oral antibiotics or isotretinoin.

Massage, wraps, radiation, and nonablative treatments

The most conservative treatments of scar tissue include several techniques that help to minimize scar formation and improve the appearance of scars that existing already.  Burn scars are treated typically with the application of pressure dressings, which restrict movement of the affected area and provide insulation. Another technique that is often used is silicone gel sheeting. The sheeting is applied to the scarred area, and remains for a minimum of 12 hours a day over a period of three to six months. It is effective in improving the appearance of keloids in about 85% of cases.

Keloids that do not respond to any other form of treatment may be treated with low-dose radiation therapy.

Nonablative treatments, which do not remove the epidermal layer of skin, include microdermabrasion and superficial chemical peels. Microdermabrasion,  is a technique for smoothing the skin. During this procedure, the physician uses a handheld instrument that buffs the skin with aluminum oxide crystals; skin flakes are removed through a vacuum tube. Microdermabrasion does not remove deep wrinkles or extensive scar tissue, but can make scars somewhat less noticeable without the risk of serious side effects. Mild chemical peels, such as those made with alpha-hydroxy acid (AHA), are used sometimes to treat acne scars or uneven skin pigmentation resulting from other types of scar revision treatment.

Risks & Complication

Scar revision surgery carries the same risks as other surgical procedures under anesthesia, such as bleeding, infection at the incision site, and an adverse reaction to the anesthetic. The chief risk specific to this type of surgery is that the scar may grow, change color, or otherwise become more noticeable.