Scar revision

Abstract

Most surgical patients end up with a scar and most of these would want at least some improvement in the appearance of the scar. Using sound techniques for wound closure surgeons can, to a certain extent, prevent suboptimal scars. This article reviews the principles of prevention and treatment of suboptimal scars. Surgical techniques of scar revision, i.e., Z plasty, W plasty, and geometrical broken line closure are described. Post-operative care and other adjuvant therapies of scars are described. A short description of dermabrasion and lasers for management of scars is given. It is hoped that this review helps the surgeon to formulate a comprehensive plan for management of scars of these patients.

Mechanotransduction in Wound Healing and Fibrosis

“…Mechanical stimuli contribute to alterations in the wound healing process and underlie the increased susceptibility to excessive scar formation found in particular regions of the body [7,8]. Modern plastic surgery already employs several mechanomodulatory procedures in order to counter these effects, including z-plasty and the use of steristrips [9,10]. Both relax skin tension at the site of the wound, effectively reducing scar development, although there remains room for improvement [11][12][13].…”

Revision of a depressed scar across a relaxed skin tension line by punch elevation, filler injection, and fractional CO₂ laser

“…Several procedures have been suggested for revision of this type of scar, including scar excision and resuturing, single or multiple Zplasty, W-plasty, geometric broken line closure, subcision and fillers, multi-stage treatment of large scars, and skin flap and grafting. However, most of these methods require special equipment, skilled hands, and occasionally multiple sessions, and they are time-consuming, costly, and associated with possible complications (2,3).…”

“…A depressed scar oriented across the RSTLs occasionally occurs due to accidental trauma or some elective situations such as removal of benign and malignant skin tumors for which the incision is inevitably oriented across the RSTLs. The depressed scar perpendicular to RSTLs can be caused either by a technical error in the procedure or the patient's healing problem (1,2).…”

The application of W-plasty combined Botox-A injection in treating sunk scar on the face

“…Although traditional methods for scar mending are simple suture or W-plasty suture can significantly improve the phenotype of scar, the satisfactory outcome is still difficult obtained. [ 8 – 10 ] In this study, W-plasty and Botox-A combined surgery was carried out. With a parallel patient's base, a significant VAS score was identified in the study group while compared with the control group which was only received the traditional repaired method.…”