Scars and Revisons – What you need to know.

This young man had a nasty deep cut and will likely be a candidate for some scar revision at a later time. It is because of the location and “linear”“direction of the scar in relation to natural skin fold and expression lines.

When a cut through the skin (even incisions for surgery) are parallel with lines naturally present there will be minimal widening of the scar. This is related to normal skin dynamics that are pulling the skin together rather than causing tension with muscle movements. We see this effect after “C” Sections for babies. The scar is placed in a “smile” position at the lower end of the tummy. After healing, these scars are barely visible.

In the emergency room, repair of traumatic cuts would include putting sutures beneath the skin layer to pull cut edges together, remove tension, and align cut surface edges. These sutures dissolve over 6-12 weeks when the scar has become strong enough to keep from widening with muscle activity in the area. What we as patients see are the sutures placed in the skin surface next that are removed in a week or so. If these sutures are left in place longer than 14 days, the holes in the skin where the sutures pass become little scars themselves and make the classical “railroad track” scar appearance.

As a scar is healing after a cut of any type, the body lays down collagen to strengthen the scar. This is much like putting metal rods in concrete to make it stronger when dry. During the first 6-8 weeks the collagen is randomly laid down in clumps. This is much like randomly pulling string or thread from a spool onto the floor. The thread essentially ends up in a jumbled pile. With scar, after six weeks or so the body begins remodeling the jumbled collagen into fibers that are aligned into more “fabric-like” arrangement that is thinner, softer, and more supple.

This maturation process continues for months, but by one year is mature enough for revising the scar surgically. It is for this reason that plastic surgeons really not need to see the scar until after the maturation process is well underway. Of course part of the surgeon or initial physician’s treatment should be to give patient’s an explanation and information about the healing process. This would normally include describing what to expect, and when revisions should/can occur, things to do or not to do during the healing, etc.

There are several techniques in the bag of surgical tools to “break up” and then disguise the scar. Most scars from injuries that simply cut the skin causing no loss of skin can be revised ultimately to be almost unnoticeable even with deep cuts. Classical repair techniques include rearranging the straight scar with “Z” plasties to break up the linear scar. They also give the illusion of the scar direction being more parallel to the normal skin lines. The finishing touches done several weeks later could include dermabrasion with sandpaper. This then heals in a few days with the same camouflage effect as wiping footprints out of a sandy beach with your hand.

 
 

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2018-08-21 20:58:16
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