Scar revision therapies replace one scar for another in an attempt to improve the aesthetic appearance of the original scar. Though the scar’s appearance may improve considerably, it is important that the patient understand that complete restoration to preinjury tissue appearance is impossible. Dr. Morse recognizes that this high emotional component must be addressed so that realistic expectations can be achieved.
Indications for Scar Revision
Patients who are candidates for scar revision procedures have often experienced significant loss of regional tissue, injury that crosses aesthetically distinct areas of the face, unsatisfactory wound closure, and poor post-injury wound management. These are individuals with scars that are functionally or cosmetically undesirable, and meet some or all of the following characteristics:
- Unfavorably positioned with respect to length and direction of relaxed skin tension lines
- Have undergone pathological healing processes
- Unfavorably cross anatomic regions
- Are constantly subjected to wrinkling of the skin
- Are deeply traumatic
Your Scar Revision Procedure with Dr. Morse
Scar revision surgery generally involves the removal of skin tissue in specific shape or pattern that, once the incision is closed, will aid in diminishing the size of the original scar. Partial or serial excisions, for example, are common treatments for scars too large to be excised in one sitting and that have have insufficient available skin for a local skin flap closure. In this procedure, an ellipse is excised from the scar’s center. The sides of wound are then undermined so that Dr. Morse can suture the site.
The Z-plasty and W-plasty are used to treat contractures and to minimize the visibility of scars by repositioning them along the natural lines and creases of your skin. In Z-plasty scar revision, Dr. Morse makes a Z-shaped incision with the middle line of the Z running along the scar tissue. The flaps of skin formed by the other lines of the Z are rotated and sewn into a new position that reorients the scar about 90 degrees, so that the appearance of the scar is minimized by breaking up the straight line of the scar into smaller units.
A hypertrophic scar (left) can form a contracture and restrict motion of the finger. Dr. Morse can perform Z-plasty to remove the scar. He makes several incisions on each side, creating small triangular flaps of skin. The flaps are then rearranged and interlocked to cover the affected area.
Like the Z-plasty, the W-plasty minimizes the visibility of a scar by turning a straight line into an irregular one. Dr. Morse makes a series of short incisions to form a zigzag pattern to replace the straight line of the scar. The primary difference between a Z-plasty and a W-plasty is that a W-plasty does not involve the formation and repositioning of skin flaps.
What to Expect After Surgery
Treatment following scar revision surgery varies; excision approaches like Z and W-plasty involve the use of pain medication, rest, and wound and bandage care. If Dr. Morse treats your scars with skin grafts or flaps, postoperative care will begin in the hospital, and sutures are removed 3-7 days after surgery. Patients receiving grafts are typically expected to return to the hospital at regular intervals so that the graft sites can be monitored.To learn more about the benefits, costs or possible side effects of scar revision surgery, contact Dr. Morse for a personal consultation.