Description of Types of Surgical 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.
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.
Adjunctive Techniques of Scar Revision
- 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.
- 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.
The reasons for a patient not to undergo scar revision include:
- The present psychological status of the patient does not prepare the patient for a positive outcome.
- The patient’s expectations are unrealistic limiting the opportunity for a favorable visible outcome.
- An individual’s history for hypertrophic and or keloid scarring represent a poor risk for a pleasing aesthetic result.
- Patient’s with thickened skin from the trauma reducing compliancy endure the risk of a compromised scar revision.