Scar revision is a procedure that is done to minimize the appearance of the scar. Scar revision can do the following:
- Improve the cosmetic appearance of the scar making it less conspicuous such that it blends in with the surrounding skin tone and texture
- Correct disfigurement
- Make the scar less itchy
- Restore function to a body part that may have restricted function due to the scar
What is a scar?
A scar is a visible sign that remains after the skin/wound has healed due to injury, tissue inflammation, infection, or surgery. It is the body’s natural reaction of replacing damaged skin. A scar is comprised of fibrous tissue and can form anywhere in the body.
Types of Scars and Their Treatment
Discoloration or surface irregularities
These types of scars do not cause physical dysfunction or impair function. They include acne scars and scars resulting from minor injuries or surgical incisions. They can be improved by surgery, topical treatments or other surface treatments such:
- Dermabrasion which is a mechanical polishing of the skin
- Chemical peels even out skin irregularities I color and texture by penetrating the skin’s surface
- Light or laser therapy helps in the formation of new healthy skin at the site of the scar
Contractures occur when there is a large amount of tissue loss possibly from a burn resulting in a scar. During the formation of a contracture scar, the edges of the skin and the underlying tissue pull together causing a tight area of the skin. This decreases the size of the skin and can affect the tendons, muscles, and joints thus restricting movement especially on the fingers, elbows, knees, and neck.
There are surgical options for treating contracture scars and they include:
- Skin flaps or skin grafts for contractures: This is done after the scar tissue is removed and it involves attaching or replacing skin to the part where there is missing skin. Skin grafts involve taking a piece of healthy skin from the donor site (another area of the body) and attaching it where it’s needed. Skin flaps also involve taking a healthy piece of skin from the donor site but with the flaps hence the skin has its own blood supply. The donor skin used for skin flaps has underlying blood vessels, muscles, and fat. Flaps are usually used when the area missing the skin lacks good supply of blood due to damaged vessels or its location.
- Tissue expansion for contractures: This treatment involves increasing the amount of existing tissue for reconstructive purposes. It is usually done alongside skin flaps.
Hypertrophic scars present as a thick bunch of scar tissue that develop directly at a wound site. They are often elevated, red, and/or uncomfortable and can widen over time. These types of scars tend to develop within weeks following an injury to the skin. They can be hypopigmented (lighter in color) or hyperpigmented (darker in color).
Hypertrophic scars can be treated with steroids which may be given by direct application or injection.
Surgery can also be done to remove hypertrophic scars. Steroid injections may also be used following surgery to help with the healing and decrease the chances of the scar returning.
Keloid scars are larger than hypertrophic scars. They present as thick, rounded, irregular bunch of scar tissue that grow at the wound site on the skin but tend to extend beyond the edges of the original incision or wound. They are red or darker in color compared to the surrounding normal skin and can be itchy or painful.
Keloids form when the connective tissues (fibroblasts) and skin cells begin to multiply so as to repair damage. They commonly develop in areas where there is little underlying fatty tissue such as the face, ears, neck, shoulders, or chest, although they can appear anywhere on the body.
Treatment for keloid scars include:
- Cryotherapy: This treatment involves freezing off the scar with medication. It is often done in conjunction with steroid injections for better results.
- Steroid injections: These are directly injected into the keloid scar tissue to help decrease the redness, itching, and burning sensations of the keloids as well as the size of the scar.
- Pressure therapy: This involves wearing a pressure appliance over the keloid scars day and night for a period of four to six months.
- Laser: Laser may be used to treat keloid scars depending on the underlying cause of the scar. Lasers can smooth the scar, flatten it, or remove the abnormal color of the scar. Laser treatment for keloid scars is usually done in conjunction with other treatments such as steroid injections, special dressings, and use of bandages. Multiple laser sessions are often required to achieve the desired results.
- Surgery: This can be a treatment option for keloid scars if the nonsurgical treatments are not responsive. Surgery can involve removing the keloid scar with a direct incision and closing the wound using stitches. Another surgical option is using skin grafts to close the wound. Radiation therapy is often done after therapy to minimize the risk of the keloid scar recurring.
Risk Factors of Scar Revision
Risk factors of scar revision include:
- Recurrence of scar
- Keloid formation
- Prolonged healing
- Separation of the wound
- Skin sensitivity
- Skin discoloration and swelling
- Persistent pain
- Deep vein thrombosis
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Reconstructive surgery at Kings College Hospital Dubai focuses on the safety and care of every patient in a compassionate environment with state-of-the-art facilities. To book an online or in-person consultation and a detailed evaluation by one of our world class plastic and reconstructive surgeons in Dubai, get in touch using the contact details given, and our patient-care staff will book an appointment for you.
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