Scar repair

Alternative names
Keloid revision; Hypertrophic scar revision; Scar revision

Definition
Surgical procedure to improve or minimize the appearance of scars, restore function, and correct disfigurement resulting from an injury, lesion, or previous surgery.

Description
Scar tissue forms as skin heals after an injury (such as an accident) or surgery. The amount of scarring may be determined by the size, depth, and location of the wound; the age of the person; heredity; and skin characteristics including color (pigmentation).

Surgery to revise scars is done while the patient is awake, sleeping (sedated), or deep asleep and pain-free (local anesthesia or general anesthesia).

Medications (topical corticosteroids, anesthetic ointments, and antihistamine creams) can reduce the symptoms of itching and tenderness. Scars shrink and becomes less noticeable as they age, therefore, immediate surgical revision is delayed until the scar lightens in color, which is usually several months or even a year after a wound has healed.

A keloid is an abnormal scar that is thicker, different color and texture, extends beyond the edge of the wound, and has a tendency to recur. It often creates a thick, puckered effect simulating a tumor. Keloids are removed at the point where it meets normal tissue.

Massive injuries (such as burns) can cause loss of a large area of skin and may form hypertrophic scars. A hypertrophic scar can cause restricted movement of muscles, joints, and tendons (contracture). Surgical repair includes removing excessive scar tissue and a series of small incisions on both sides of the scar site, which create V-shaped skin flaps (Z-plasty) may be used. The result is a thin, less noticeable scar because the wound closure following a Z-plasty more closely follows the natural skin folds.

Skin grafting involves the taking a thin (split thickness) layer of skin from another part of the body and placing it over the injured area. Skin flap surgery involves moving an entire thickness (full thickness) of skin, fat, nerves, blood vessels, and muscle from a healthy part of the body to the injured site. These techniques are planned when a considerable amount of skin has been lost in the original injury, when a thin scar will not heal, and when improved function (rather than aesthetic reasons) are the primary concern. Secondary procedures may later be necessary to achieve appropriate aesthetic results.

Indications
No scar can be removed completely. The degree of improvement will depend on variables such as the direction and size of the scar, the age of the person, skin type and color, and hereditary factors that may precondition the extent of the healing process.

RISKS
Risks for any anesthesia are:

     
  • reactions to medications  
  • problems breathing

Risks for any surgery are:

     
  • bleeding  
  • infection  
  • blood clots  
  • scar recurrence  
  • keloid formation (or recurrence)  
  • dehiscence (separation) of the wound

Excessive sun exposure to a scar may cause darkening, which could interfere with future revision.

Expectations after surgery
A pressure or elastic dressing may be placed over the area following the operation to discourage recurrence of the keloid. For other types of scar revision, a light dressing is applied and sutures are usually removed in 3 to 4 days for the facial area, and 5 to 7 days for incisions on the body elsewhere.

Convalescence
The decision on when to return to normal activities and work depends on the type, degree, and location of the surgery. Most people can resume normal activities soon after surgery. Avoidance of activities that stretch the new immature scar and may widen the scar is usually recommended.

If a long-standing contracture is present, physical therapy may be required in addition to surgery to restore full function.

Exposure to the sun should be avoided for several months following treatment. Sunblockers or a dressing (such as a Band-Aid) will keep the sun from permanently tanning the healing scar.

Johns Hopkins patient information

Last revised: December 4, 2012
by Janet G. Derge, M.D.

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