Scar revision surgery refers to a group of procedures done so as to partially or completely remove a scar tissue, after a surgery or injury. While the surgery aims to improve the appearance of the face or other body part, it also serves to restore and improve normal functioning of muscles and joints.
Scar tissues are formed when the skin heals after an injury or surgery and the intensity of scarring depends on the size of the wound, location, depth, heredity, age and skin colour. Depending on how the surgery is performed, the patient may be given local or general anaesthesia. There are two types of scars that are treated – keloids and hypertrophic scars. Keloids are soft and shiny benign tumours that shoot up in the areas of affected skin whose growth is irregular. Hypertrophic scars are thick, ropy-structured scars that are formed due to contractures of skin.
The treatment method followed for scar revision is greatly individualized and the number of operations required may vary depending on the healing process involved. The following procedures are generally practised.
Surgical Excision is a procedure in which the scar tissue is cut or shaved to reduce the size of scar. This method is generally followed for larger wounds and is done in stages.
Flaps, Grafts and Artificial skin implants – the procedure is used to treat contractures and larger scars formed from burns and other traumatic injuries. A cut is made to remove the scar tissue and the surgeon implants a skin graft or flap taken from the site of the injury or from some other donor site that matches in colour and texture of the affected area. Once placed, the implants attach themselves to the nearby tissues.
Dermal degeneration templates, also called artificial skin, are used to treat severe scars. The templates are made of two layers. The top layer is made of silicone and the bottom layer is made of collagen obtained from cows. During the surgery, the surgeon removes all the scarred tissues from the wound and places the template at the site. The collagen layer is easily absorbed and initiates new skin formation while the silicone layer covers and protects the wound. After three weeks, the silicone layer is removed and a thin graft of the patient’s skin is placed over the wound.
Z-plasty and W-plasty are surgical techniques that involve repositioning the scars along creases to decrease visibility. In Z-plasty, a Z-shaped incision is made with the middle line of Z placed over the scar tissue. The flaps of skin from the other lines of Z are rotated and sewn. This process reorients the scar by about 90 degrees. Thus a scar is broken into smaller units. In W-plasty, the surgeon makes several incisions in zigzag pattern to alter the straight line of the scar and convert into several smaller scars that become less visible. This procedure does not involve the use of flaps.
Laser Skin Surfacing and dermabrasion are techniques used to treat acne scars or scars with uneven surfaces. They involve removing top layer of the skin. In dermabrasion, a high speed rotating wheel is run over the scar tissue and surrounding skin several times so as to smoothen the skin surface. Laser skin resurfacing makes use of a carbon-dioxide or Er.YAG laser, which evaporates the top layer of the skin and tightens the underlying dermis layer. Whatever maybe the procedure used, avoid exposure to sun for several months. Use sunblock or adhesive bandage because the healing scar is prone to permanent tanning by rays of sun.