In 2012, we published the article “Scar on the body, five ways to cure it” in Health News, after the publication of the article, we received a large number of letters from scar patients, consulting on some of the treatment methods mentioned in the article. In order to satisfy the requests of scar patients, we have reproduced the original article from the original health newspaper and used some typical cases to explain the various methods mentioned, hoping to be useful to the majority of scar patients.
Scar, in the words of the common people, is called scar or scarab. Whenever there is a trauma to human skin, no matter how big or small, a certain degree of scar is eventually formed. The formation of scar is the inevitable result of the healing of trauma in the body. Moderate scar formation is a normal physiological manifestation of the body and is a very important self-protective measure of the human body; excessive scar proliferation is a pathological change.
There are many causes of scarring, such as car accidents, knife cuts, burns, scalds, infections, etc. There are also medical scars, such as those caused by surgical procedures.
Some keloid scars grow like a tumor
There are three types of keloid scars: normal keloid scars, proliferative keloid scars and keloid scars. In general, after a person suffers an injury to the skin, a scar forms at the site of the injury (such as a post-surgical cut). If, over time, the scar slowly becomes less visible and gradually approaches the surrounding normal skin, this is a normal scar. A proliferative scar, on the other hand, is characterized by being very hard, congested, red, and does not soften for a long time, even 3 to 5 years.
In some people, the keloid scar will proliferate beyond the original injury site and has a tendency to grow tumor-like, and the lesion will easily recur after excision, even if the resulting scar is far beyond the pre-surgical area, which is the keloid scar. Keloid is one of the difficult problems in plastic surgery. Although it is not a tumor, it has the growth characteristics of a tumor and the lesion is extremely prone to recurrence after excision. To prevent recurrence, a combination of radiation therapy, local compression therapy, and hormone therapy are also performed after removal of the lesion. Keloid scars usually appear about 1 year after skin injury and generally appear as a persistent lump growing above the surrounding normal skin and beyond the original injury site, hard to the touch, with poor elasticity and significant local itching and pain symptoms. Keloid scars are more common in women, and the prevalent sites are mainly concentrated in the upper part of the body, such as the forehead, shoulders, back, and earlobes.
When to start scar treatment
If keloid scars appear on your child, it is important to treat them as soon as possible. Because children develop quickly, if not treated early, the scar may affect the child’s growth and physiological functions, such as neck scar restricts the child’s head lifting and affects eating and some other activities of daily living. For adults, if the scar does not affect the function and is only an aesthetic issue, it is more appropriate to undergo cosmetic surgery after the scar has been formed for at least 6 months; within 6 months, the scar is unstable and there is local congestion, so it is difficult to guarantee the results of scar treatment at this time.
What methods can be used to remove keloid scars
Currently, surgery is still the main method of scar treatment. There are various surgical methods for scar treatment, each with its own indications. The main surgical treatment methods are.
1. Scar excision with direct suturing.
The surgery is relatively simple and can be done in an outpatient setting. The scar is excised directly and then carefully sutured. It is mainly suitable for scars that are not very wide and the surrounding tissues are relatively loose, such as those formed after car accidents or glass scratches.
Case presentation: This patient had an unsightly hyperplastic scar on her forehead and eyebrows due to trauma, which seriously affected her aesthetics. Considering that this patient’s scar was not very wide and the local skin looseness of the scar was relatively good, we decided to treat him with direct scar excision sutures. After surgical excision, we used layered sutures on the incision to minimize the tension of the incision and sutured the surface skin with 7-0 monofilament nylon thread to minimize the incision scar and stitching scars.
In addition, even for wider scars, the “scar excision and suturing in stages” method can be used to treat the scar, specifically by excising a portion of the scar during the first surgery and then suturing it, so that the original scar can be significantly narrowed; after waiting for 6-12 months, due to the looseness of the skin itself, the original tighter skin will become tighter. After 6-12 months, due to the looseness of the skin itself, the original tight skin becomes looser, and the second scar removal surgery can be performed to finally remove the scar completely.
2. “Z” plastic surgery.
This is a classic procedure to loosen the scar contracture deformity, which is simple and effective. The specific steps are to make an incision at the scar site, form two triangular flaps in a “Z” relationship, exchange the positions of the triangular flaps, and then suture them together. This interrupts the scar and mobilizes the normal tissue around the scar to release the scar contracture. This method is often used to correct scar contracture deformities in the joint area. The original “I” shaped scar is cut into a “Z” shape to relieve the tension of the scar and prevent postoperative scar growth. For example, the scar in the axilla may cause skin contracture, if the scar is cut into a “Z” shape, the axilla can be opened and the function of lifting the upper arm will not be affected.
Case introduction: This is a patient with a hyperplastic scar formed on the face and in front of the ear after facial trauma, and since the scar was not very wide, it could be excised and sutured directly. Therefore, after excision of the scar, we also perform a Z-plasty, which interrupts the straight line contracture of the incision and ensures the long-term treatment effect after the surgery.
In fact, in clinical work, for the convenience of explanation, some doctors will explain to their patients that in order to obtain a better scar treatment result, the incision is closed in a “serrated” or “wavy” shape, and in most cases, the doctor means to Z-plasty; somewhat similar to the shape of the scar on the forehead of the hero of the movie “Harry Potter”.
3. Skin Grafting.
After scar removal, there will be a relatively large skin defect that cannot be directly sutured, then a piece of skin including epidermis and part of dermis can be removed from other parts of the body and transplanted to the defect area. The advantage of this method is the short treatment time and low cost, but the disadvantage is that it leaves scarring on other parts of the body and the transplanted skin piece will develop hyperpigmentation and contracture in the long term. Currently this treatment is mainly used for the early treatment of patients with severe burns.
Case presentation: This is a patient with severe flexion deformity of the index, middle and ring fingers due to burns, and the upper three fingers cannot be fully straightened due to the presence of scar contracture. The best method of treatment is to excise the scar in time to completely loosen the contracture, and then, in other parts of the body, cut skin pieces and transplant them onto the ventral trauma of the fingers; strengthening the functional exercise of the fingers after the surgery can generally obtain good therapeutic results.
4. Skin expansion.
This is a new technique that has been developed in the field of plastic surgery in the last 30 years. A special skin expander is placed underneath the normal skin and saline is injected into the expander periodically through the expander’s injection jug to increase the volume of the expander, thus causing the skin above the expander to be stretched and increased in size. In this way, “extra” skin is obtained and used to repair the skin defect formed after scar excision. Because the defect is repaired by applying the surrounding normal skin, the long-term treatment results are very good.
Case presentation: This is a case of a patient with a post-burn chest scar, the presence of which seriously affects the aesthetics of the chest and is accompanied by itchy and painful symptoms. Since the patient was a male, he could not be overly concerned about breast development. Therefore, during the first surgery, we first buried a skin expander on the right side of the scar, and after the wound grew, we injected saline into the skin expander one after another, so that the skin next to the scar was gradually stretched, and after the skin expansion injection was completed, the scar on the chest was excised and the normal skin expanded from the right side of the scar was used to cover the The normal skin on the right side of the scar is used to cover the trauma.
5. Microsurgery.
If the scar is large and there is no normal skin available around it after scar excision, a composite piece of tissue including skin, subcutaneous tissue and blood vessels can be cut from another part of the body, which is called a flap. Through microsurgery, the blood vessels on the flap are sutured to those in the defective area to provide a blood supply to the flap. This method differs from skin grafting in that the flap will not develop hyperpigmentation and contracture in the long term because of the blood supply, and is suitable for some severe scar contractures.
Case presentation 5: This is a patient with severe facial and cervical scars caused by burns, characterized by large and thick facial and cervical scars, and it is difficult to achieve good treatment results by applying methods such as skin grafting or skin expansion. Therefore, after removing all the scars, we cut a flap with blood vessels in the back (parascapular flap), and the part of the back that provides the flap can be directly pulled together and sutured, then, the flap is transferred to the face and neck for covering the wound formed after scar removal, and at the same time, the blood vessels in the back are sutured together with those in the face and neck under the microscope to restore the blood supply of the flap, and after the surgery, the flap, no matter from After the surgery, the flap is close to the skin of the face and neck in terms of color, texture and thickness.
Is the long-term effect of scar treatment good?
For superficial scars of small size, if reasonable and effective preventive treatment measures are taken in time, although the scar cannot be completely removed, a less conspicuous and almost close to normal result can be obtained. For larger or deeper scar or even contracture deformity caused by scar, the main purpose of treatment is to restore function, and usually the ideal state of complete disappearance of scar and return to normal appearance cannot be achieved.
To receive the most ideal treatment effect, the collaboration of the patient, family and medical staff is required. In the early stages of scar formation, patients should be seen at a professional scar treatment center in a timely manner, and a personalized treatment plan should be developed by a senior scar treatment specialist. There are many severe scar deformities that require long-term and continuous treatment and cannot be abandoned halfway, otherwise they will affect normal development and normal activities.