Scar Truths and Tales

Scars, who doesn’t have one? A little annoying insect bite gets scratched obsessively becomes infected and though not deep it scars. The athletic endeavors of youth, life threatening accidents, surgery or to the catastrophic injuries of war can all leave our bodies scared. Scars can be the source of pride for some an icebreaker to tell an embellished tale at a family event or hob-knobbing with friends.

Scars can just be minor footnotes to our lives or major source of emotional and psychological angst. One on my right palm once stretched the full width; now, it is barely noticeable unless pointed out. It marks a dramatic bloody incident of falling in a 2nd grade foot race at recess. Then there is the one near my right eye a story that I don’t often want to recount. The visible one on my right shoulder blade always invites comment in a shirtless pickup game of basketball. Scars can be mileage markers on the amazing journey of our life. Sometimes, those scars bare even more tragic consequences to some people. They can infringe upon their well-being and devastate their quality of life.

The more I reflect my hands begin to braille my body through my clothing and my mind shuffles through vignettes of memories of burns and bruises, scrapes and scabs; bumps and lumps. Limbs and torso marked by stitches and scratches, gashes and slashes; all with the requisite blood; some of these scars bleeding more profusely causing parental angst and a flood of tears.
My active childhood, athletics and sporting lifestyle have given my dermis a lifetime of stories and embellished tales to share. Not a one would I remove. They are my story for better and worse.

By now you’re asking the purpose of this tale. My many scars have left to date only memories to be romanced and morphed into heroic tales. This is not true for many people. Scarring can deeply mar the psyche of a person and impact their life at every level.

Scar revision provides an opportunity to effect positive change on such people’s self image and esteem. The effect of scarring can be compounded by the onset of depression; a too often debilitating life-cycle if untreated.

It can be a vitally important step in their journey to inner and outer healing to treat the scar through the wonderful advancements in scar revision treatment. If you or a family member or friend struggle with issues regarding scars; consult with a dermatologist and or cosmetic surgeon. Scar revision in the 21st century has come a long way in providing wonderful results for many.

Listed below are the most common surgical techniques utilized in scar revision.

Z-plasty is a reconstructive surgery procedure. Its utilization is for improving the functional and aesthetics of scars.  Functionally refers to the lengthening of the scar the lengthening of a scar which helps relax or release linear burn scar contractures. The availability of mobile adjacent skin is a predicator for the use of this medical procedure. Z-plasty can procedurally make the scar less noticeable. Re-alignment of the central element can place the scar in natural skin tension lines and thereby disguise it. Utilizing this procedure the surgeon can rotate the tension line of a scar and or make a contracted scar elongated. In Z-plasty the midline of the Z-shaped incision is made along the meridian of highest tension or contracture. Triangular flaps are raised on the opposite ends of this incision. The flaps are than transposed and closed.

W-plasty is another reconstructive plastic surgery technique used for the excision of unaesthetic scarring. The excised edges of the scar are cut in a zig-zag pattern is like a connected row W’s. The borders are interdigitated for suturing. This method is very effective in rendering a linear scar irregular and less visible.

W-plasty revisions the scar into a ‘pinking shear pattern; which will interlock when sutured. Optically, it is more difficult for the eye to follow an irregular line. This makes W-plasty a favored method for revisioning linear scars. Often there is no discreet skinfold to hide a scar. Think of areas such as the forehead, the side of the face or cheek. Still is the irregular pattern is uniform visibility is not obscured. For that reason W-plasty is most often combined with

Geometric Broken Line Closure (GBLC).

W-plasties are not usually employed on their own throughout the entire scar. Visibility of the scar can be better reduced by combining other patterns with the W pattern. This is a more sophisticated procedural technique of scar revision is known as geometric broken line closure (GBLC).  W-plasty is the basic technique and then other shapes besides triangular flaps are utilized for interdigitation creating a very irregular irregularity. This procedure offers the optimal potential for camouflaging the scar. Added to this is also dermabrasion which is done approximately two to three months after the surgery.

M-plasty

The object of electing M-plasty in reconstructive surgery is to better preserve healthy tissue and to reduce the chance of secondary tissue deformity.  Proper technique in M-plasty reduces the loss of surrounding health tissue by nearly fifty percent.  The M-plasty is performed by creating two separate thirty degree angles instead of a single one.

Dermabrasion

• precisely and in a controlled deliberate manner superficial abrading of the scar and surrounding skin. The end result is a smooth texture and in some cases further reduced visibility.
• Abrasion can be used in a process that will improve the appearance of uneven scar edges including: scar edges, grafts and or flaps.
• Dermabrasion works best on lighter complexions because of the lower risk of dyspigmentation.

Intralesional Steroids

• Hypertrophic linear scars, bulky grafts and flaps, can be treated with intralesional corticosteroids. Injections can be instituted at approximately 1 month postoperatively.
• A small amount (as little as 0.1 mL) of low-dose triamcinolone acetonide  at 5 to 10 mg/mL is injected into the scar; this dosage can be repeated monthly until the scar has flattened.
• Side effects include atrophy (if the injection leaks out into healthy skin ),  hypopigmentation and telangiectasias when injected in higher concentrations into the dermis.

Contraindications

The reasons for a patient not to undergo scar revision include:

1. The present psychological status of the patient does not prepare the patient for a positive outcome.
2. The patient’s expectations are unrealistic limiting the opportunity for a favorable visible outcome.
3. An individual’s history for hypertrophic and or keloid scarring represent a poor risk for a pleasing aesthetic result.
4. Patient’s with thickened skin from the trauma reducing compliancy endure the risk of a compromised scar revision.