SCAR REVISIONS

When skin is damaged, the body’s natural way of replacing it is by producing a scar. Fibrous tissue frequently makes up scars. Scars can develop for a variety of reasons, including infections, surgery, traumas, or tissue inflammation. Anywhere on the body, a scar can develop, and its structure might differ, appearing flat, lumpy, sunken, or coloured. The scar could hurt or itch. The final appearance of a scar is influenced by a number of variables, including the person’s age, nutritional state, skin type, where the scar is on the body, and the direction of the incision.
A surgery to change a scar’s appearance is known as a scar revision. The repair may enhance the scar’s aesthetic appeal, allow movement in a body region that the scar may have limited, or soothe an itchy scar. It’s critical to keep in mind that scars cannot be entirely eliminated.

What are the different types of scars?

4 different types of scars are known to exist, these are:

• Surface irregularities or discolourations- Acne scars, scars from minor injuries, scars from previous surgical incisions, all of these forms of scars do not interfere with function or create physical discomfort.
• Hypertrophic scars- Hypertrophic scars are dense clumps of scar tissue that form just at the site of a wound. They are frequently elevated, painful, red, and/or raised, and they may enlarge over time. Hyperpigmented people have darker skin than hypopigmented people (lighter in colour).
• Keloid scars- Hypertrophic scars are smaller than keloids. They may pucker and be uncomfortable or irritating. They go beyond an initial wound or incision’s borders. Although keloids can grow everywhere on the body, they are more common on the face, neck, ears, chest, and shoulders where there is less underlying fatty tissue.
• Contractures- Contractures are scars that limit movement as a result of the underlying tissue and skin pulling together when the wound heals. When there is significant tissue loss, such as after a burn, they can happen. Where a wound crosses a joint, contractures can also develop, limiting motion in the fingers, elbows, knees, or neck.

 

What preparation should be done before the scar revision surgery?

Before the surgery, your doctor may ask you to do the following things:

• Get certain tests done
• Adjust medications
• Stop smoking in advance
• Avoid anticoagulants and anti-inflammatory medicines

 

What are the different scar revision procedures?

The management of scars varies according to the type of the scar.

Keloid scars: There are various keloid scar treatments. In order to get rid of keloid scars, there is no simple fix. Following treatment, recurrence is frequent. The following may be part of the treatment:

• Steroid injection: To assist lessen the stinging, burning, and redness that these scars may cause, steroids are directly injected into the keloid scar tissue. In certain cases, the injections really assist in reducing the scar’s size.
• Cryotherapy: A drug is used in cryotherapy to “freeze off” the scar. When combined with steroid injections, this therapy is frequently successful in treating keloid scars.
• Pressure treatment: A specific sort of pressure appliance is worn over the location of the keloid scar during pressure therapy. For a maximum of four to six months, these may be worn day and night.
• Surgery: Surgery may be performed if nonsurgical therapy approaches are ineffective for treating the keloid scar. In one kind of surgery, the scar is directly removed through an incision, and stitches are used to assist seal the wound. Skin grafts may occasionally be applied to assist close the wound. This entails adding skin to the missing area or replacing it. When doing skin grafts, a healthy patch of skin is removed from the donor site and stitched to the place that needs it.
• Laser therapy: Laser surgery is an additional keloid scar therapy option. Depending on the underlying cause of the scar, different lasers may be used to cure it. A scar may be flattened, have its odd hue removed, or smoothed with laser technology. The majority of times, steroid injections, specialised dressings, and bandages are used in addition to laser therapy for keloid scars.

Hypertrophic scars: Although there isn’t a single straightforward treatment for hypertrophic scars, steroids may be the first line of therapy. Steroids can be used topically or administered intravenously. Surgery is another option for removing these scars. In order to speed up healing and reduce the possibility of the scar reappearing, steroid injections are frequently administered concurrently with surgery and may be continued for up to two years afterward.

Contractures: Surgical options for contractures are-

• Skin graft or skin flap- After the scar tissue is removed, skin grafts or skin flaps are applied. In skin grafts, the lost skin is replaced or joined to the skin-less area of the body. In order to accomplish a skin transplant, a piece of healthy skin from another part of the body, known as the donor site, is removed and attached to the desired area. In skin flaps, the skin that is recovered has its own blood supply, unlike in skin grafts where a portion of the skin is removed from another place. The underlying blood arteries, fat, and muscles are present in the skin flap that is used. When the area where the skin is removed has a poor blood supply due to its location or because of damage to the blood vessels, flaps may be employed.
• Tissue expansion- A more recent method for treating scars called tissue expansion involves a procedure that expands the amount of tissue already present that can be used for reconstruction. The flap surgery is frequently used with this treatment.

 

What can be expected during recovery from the surgery?

The first week or so of a surgical scar revision recovery may be characterised by regional swelling, discolouration, or discomfort. For several weeks, the new scar will heal and gradually improve and diminish as it does so. You may also experience general sensitivity in the operated region.
Your scar revision surgery will have long-lasting effects, but it can take some time before you see them. In some situations, it might even take a year for the new scar to entirely recover and fade.

Scar revisions are becoming increasingly popular and have a good success rate. To know more about the procedures and to select the procedure suitable for your condition, contact your doctor. They will help you come up with an optimal plan of action suitable to your needs.