Scar revision

Description:
Scar tissue forms as skin heals after an injury (such as an accident) or surgery. The amount of scarring may be determined by the size, depth, and location of the wound ; the age of the person; heredity; and skin characteristics including color (pigmentation).

Surgery to revise scars is done while the patient is awake, sleeping (sedated), or deep asleep and pain-free (local anesthesia or general anesthesia).

Medications (topical corticosteroids, anesthetic ointments, and antihistamine creams) can reduce the symptoms of itching and tenderness. Scars shrink and becomes less noticeable as they age, therefore, immediate surgical revision is delayed until the scar lightens in color, which is usually several months or even a year after a wound has healed.

A keloid is an abnormal scar that is thicker, different color and texture, extends beyond the edge of the wound, and has a tendency to recur. It often creates a thick, puckered effect simulating a tumor . Keloids are removed at the point where it meets normal tissue.

Massive injuries (such as burns ) can cause loss of a large area of skin and may form hypertrophic scars. A hypertrophic scar can cause restricted movement of muscles, joints, and tendons ( contracture ). Surgical repair includes removing excessive scar tissue and a series of small incisions on both sides of the scar site, which create V-shaped skin flaps (Z-plasty) may be used. The result is a thin, less noticeable scar because the wound closure following a Z-plasty more closely follows the natural skin folds.

Skin grafting involves the taking a thin (split thickness) layer of skin from another part of the body and placing it over the injured area. Skin flap surgery involves moving an entire thickness (full thickness) of skin, fat, nerves, blood vessels, and muscle from a healthy part of the body to the injured site. These techniques are planned when a considerable amount of skin has been lost in the original injury, when a thin scar will not heal, and when improved function (rather than aesthetic reasons) are the primary concern. Secondary procedures may later be necessary to achieve appropriate aesthetic results.

Indications:
No scar can be removed completely. The degree of improvement will depend on variables such as the direction and size of the scar, the age of the person, skin type and color, and hereditary factors that may precondition the extent of the healing process.

What to Expect After:
A pressure or elastic dressing may be placed over the area following the operation to discourage recurrence of the keloid. For other types of scar revision, a light dressing is applied and sutures are usually removed in 3 to 4 days for the facial area, and 5 to 7 days for incisions on the body elsewhere.

Convalescence:
The decision on when to return to normal activities and work depends on the type, degree, and location of the surgery. Most people can resume normal activities soon after surgery. Avoidance of activities that stretch the new immature scar and may widen the scar is usually recommended.

If a long-standing contracture is present, physical therapy may be required in addition to surgery to restore full function.

Exposure to the sun should be avoided for several months following treatment. Sunblockers or a dressing (such as a bandaid) will keep the sun from permanently tanning the healing scar.

Risks:
Risks for any anesthesia are:

Risks for any surgery are:

Excessive sun exposure to a scar may cause darkening, which could interfere with future revision.

Cost:
The costs of any surgery varies significantly between surgeons, medical facilities, and regions of the country. Patients who are younger, sicker, or need more extensive surgery will require more intensive and expensive treatment.

Surgery charges can be separated into five parts: 1) the surgeon's fee, 2) the anesthesiologist's fee, 3) the hospital charges, which includes nursing care and the operating room, 4) the medications, and 5) additional charges.

1. Surgeon's fee: variable
2. Anesthesiologist's fee: averages $350 to $400 per hour
3. Hospital charges: basic rate averages $1,500 to $1,800 per day (more for the intensive care unit (ICU) or private rooms)
4. Medication charges: $200 to $400
5. Additional charges: assisting surgeon, treatment of complications, diagnostic procedures (such as blood or X-ray exams), medical supplies, or equipment use.

Insurance coverage for surgery expenses depends on many factors and should be explored for each individual instance.


Keloids are overgrowths of scar tissue that follow injuries. Keloids may appear after such minor trauma as ear piercing. Dark skinned individuals tend to form keloids more readily than lighter skinned individuals.



Keloids are overgrowths of tissue that follow injuries. Keloids may appear after such minor trauma as ear piercing. Dark skinned individuals tend to form keloids more readily than lighter skinned individuals.



Keloids are overgrowths of scar tissue that follow skin injuries. Keloids may appear after such minor trauma as ear piercing. Dark skinned individuals tend to form keloids more readily than lighter skinned individuals.



Keloids are overgrowth of scar tissue that may develop after injuries, even minor trauma. In this case, the excessive scar tissue occurred at the site of shingles (herpes zoster). Dark-skinned individuals tend to form keloids more readily than lighter skinned individuals.



Keloids are overgrowths of scar tissue that follow skin injuries. Keloids may appear after such minor trauma as ear piercing. Dark-skinned individuals tend to form keloids more readily than lighter skinned individuals. These patches of keloid have become darkly pigmented.



A keloid is a type of exaggerated (hypertrophic) scar that usually appears following an obvious injury. Keloids may expand beyond the margin of the scar to include normal skin.