Scar revision

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Keloid, on the foot	Keloid, pigmented	Keloid above the ear	Keloid scar
Scar revision - series

Surgical procedure to improve or minimize the appearance of scars, restore function, and correct disfigurement resulting from an injury, lesion, or previous surgery.

Keloid revision; Hypertrophic scar revision; Scar repair

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 (local anesthesia), sleeping (sedated), or deep asleep and pain-free (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, a different color and texture than the rest of the skin, 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 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, full thickness of skin, fat, nerves, blood vessels, and muscle from a healthy part of the body to the injured site. These techniques are used 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. Additional procedures may be necessary to achieve appropriate aesthetic results.

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.

Review Date: 06/10/2005
Reviewed By: Joseph P. Hart, MD, Division of Vascular Surgery, department of Surgery, Medical College of Wisconsin, Milwaukee, WI. Review provided by VeriMed Healthcare Network.