Scar definition
“Scar” refers to the damage caused by physical, biological and chemical factors to the soft tissues of the human skin, and when the damage cannot be repaired by the original tissue cells, it is repaired by fibrous tissue instead, resulting in scars. “Scars” bring great physical and mental pain to patients, especially scars left after burns, scalds and severe trauma. Scars are often accompanied by itching, pain and symptoms, and their proliferation and contracture often lead to limb and facial dysfunction and deformity, causing great physical and psychological barriers to patients.
Characteristics of scars, hazards and preventive measures
Scars are raised in a verrucous proliferation, with a smooth surface, red and shiny color, and dilated capillaries in the scars. The scars protrude outward and have crab foot shaped changes. The scars are hard and itchy or have a painful, burning sensation. The pain may be acute and may be due to sensitive nerve endings or the formation of microneuromas, and may even be painful when lightly touched by clothing. Scars are more common on the chest, shoulders, neck, back, and ears, and rarely on the eyelids, palms, feet and plantar areas, and external genitalia.
Although scars are more common, their cause is still unknown, which makes treatment difficult. It has become a challenge for today’s medical community to inhibit the frenzied proliferation of fibroblasts and prevent their recurrence and continued growth. Currently, the following methods of treatment are available: surgical excision, abrasion, laser, radiation, local seal, freezing, etc. Single treatment often fails to achieve satisfactory results and tends to worsen the affected area. For example, surgical excision has a high recurrence rate, laser closure is often painful, and a variety of pathologies occur, such as menstrual disorders in women and impotence and obesity in men.
Skin grinding pinning, laser and freezing cannot prevent recurrence, which makes it very difficult for many patients and doctors. The prevention of scars mainly lies in the immature stage before and between the formation of scars to prevent various deformities and dysfunctions caused by scars to the organism.
Classification of scars
1.Depressed scars
2.Proliferative scars
3.Superficial scars, mostly caused by light abrasions or superficial (superficial dermis) burns on the skin. Its surface is rough or has pigmentation changes (such as skin erythema, white spots or hyperpigmentation), generally without functional disorders.
4.Keloid scars: without obvious causative factors, the scars expand to the periphery, forming crab-footed or centipede-shaped, butterfly-shaped, round-shaped, hard, light red or dark red, itchy, sometimes accompanied by paroxysmal sharp pain or tingling.
Troubling scars
1.Facial scars, which can cause deformation of the five senses or restrict the function, such as the corners of the eyes and mouth.
2.Scars on the joints of the extremities, causing restriction of movement.
3.Long and wide scars.
4.Scars with hypertrophic bulges.
5. Scars with depressed crepe folds.
6. scars with hyperpigmentation or color accentuation that do not match the color of the surrounding skin
7. Scars that do not match the texture of the surrounding skin.
8. Scars with obvious uncomfortable symptoms, such as itching, burning, pain or surface ulcers.
Prevention of scars
1.Correct wound treatment, whether it is a trauma, burn, skin infection or surgery, scars will be produced after the wound heals, and correct wound treatment can reduce the production of scars.
2.After the wound stitches are removed or the wound is initially healed, massage therapy and compression therapy will be started as appropriate.
3.Silicone sheets are pressed onto the healed scars to prevent and inhibit scar proliferation.
4.Pressure therapy can inhibit scar proliferation.
5.Massage therapy can soften hard scars.
6.For large scars, compression therapy can be done by wearing pressure garment.
Pre-operative preparation and related consultation
1.Unless only superficial epidermis is injured, most skin trauma or surgical cuts will cause healing scars of varying degrees.
2, “Once a scar, always a scar”, so far, the medical profession is still unable to completely eliminate scars. Nowadays, all surgeries, drugs and lasers cannot make scars disappear, but a certain degree of improvement is possible. Especially through the skillful hands of plastic surgeons, we hope to satisfy our patients.
Once a scar is created, the plastic surgeon can only ‘repair’ the scar rather than ‘eliminate’ it to minimize the disturbance to daily life and to take into account the requirements of functional reconstruction and aesthetic improvement.
4. Scars that cause limited motor function must be treated as soon as possible to avoid permanent joint function impairment.
5.Unsightly scars are usually considered from three aspects, i.e. size of the area, degree of elevation and depression, and color depth.
6.Small scars can be surgically excised and carefully sutured with some revision surgery so that the wound healing can be completed with minimal tissue tension and the scar becomes a linear scar.
7. If the scar is too large, it may have to be completed by multiple excisions and complex surgeries such as local flaps or remote flaps.
The scar formation process can be divided into three stages, i.e. inflammatory reaction stage, fibroplasia stage and mature stage, usually before maturity, many preventive methods can be used to reduce unsightly scars.
9. It is often seen that after a period of surgical excision, the scars of some people not only reappear, but also become more obvious than before, indicating that the person has a body type prone to “crabfoot swelling”, and it is not suitable to solve the problem by surgery.
10. How to distinguish between “crabfoot swelling” and “hyperplastic scars” must be judged by a plastic surgeon.