The preparation for scar correction surgery
Make sure that you are ideally in optimal health and rested condition just before surgery.
- Under no circumstances should you take aspirin or similar medicines fourteen days before the procedure
because they inhibit blood clotting. If you regularly take other medications, discuss this with the doctor first.
- Restrict the consumption of alcohol and nicotine a few days before the operation to a minimum. It is best to stop smoking altogether.
- For recovery, schedule several days off after the procedure.
- Before the operation clarify all questions in detail, it is best to make a note of your questions. Before each intervention, the patient must sign a so-called consent form. This form documents the planned procedure and the associated risks.
The operation of different scars
Itchy and overly proliferating scar tissue that grows beyond the scar lines is called a keloid or scar skeleton. Often, keloids are reddish or at least darker than the surrounding skin. Keloids continue to grow after wound healing has finished. They can occur anywhere on the body, but usually on the ears, shoulder and upper chest area. They are more common in dark-skinned people than fair-skinned. The tendency to keloid formation decreases with age.
Treatment with regular injections of corticosteroids directly into the keloid tissue reduces symptoms such as redness, itching and burning and can even lead to a reduction of the scar. If the injection treatment is insufficient, the scar tissue can be completely removed. This is usually done on an outpatient basis under local anesthesia.
You can return to your usual job within a day or two. Rarely, a small skin grafting to cover the resulting skin defect is required, which in turn can lead to a new keloid formation at the site of skin removal.
Since keloids recur very often, sometimes larger than before, combined methods must be used. For example, a surgical scar removal in conjunction with an injection treatment or irradiation. Pressure bandages alone or in combination with silicone films that have to be applied over a whole year may also delay a recurrence. Nevertheless, repeated treatment is the rule rather than the exception.
Similar to a keloid, the thick, reddish, raised tissue looks like the hypertrophic scar. However, hypertrophic scars remain near the original wound border and do not proliferate beyond it. Treatment with corticosteroids may help to promote self-healing of these scars. However, the healing phase can take a year.
Alternatively, hypertrophic scars can also be treated by plastic surgery. The scar tissue is removed via an inconspicuous incision. As with Keloid treatment it is usually possible to operate on hypertrophic scars on an outpatient basis and under local anesthesia. Intraoperative injection treatment with corticosteroids at regular intervals up to two years after surgery prevent new hypertrophic scars.
Skin injuries, such as burns, which result in the loss of tissue, can produce a tight, contracted scar called contracture. Such a scar may enclose adjacent tendons and joints, thereby impairing or preventing normal joint function.
Techniques such as skin stretch through implantable expanders can be used. After the treatment of the contracture in a joint normal functioning can be achieved by physiotherapy and adaptive yoga.
Scars in the facial area
In the facial area, non-hypertrophic scars are often considered a cosmetic problem. Various methods are used to make scars in the facial area less noticeable.
If the scar lies across the natural skin lines, a shift along the tension lines (eg through a Z-plastic) can already lead to a significant improvement. Other scars on the face (such as acne) can be alleviated by dermabrasion. Dermabrasion removes the top layers of skin with a special, high-frequency sander. This procedure smooths the skin surface, but does not make the scar completely invisible.
Z-plasty is a plastic surgical method to better fit a scar in the skin's natural tension lines. Even with contractures, a relaxation of the tissue and thus a significant improvement in the appearance can be achieved. However, Z-plasty is not the appropriate treatment for all scars. Whether or not it is suitable in individual cases is reserved for the judgment of an experienced specialist in aesthetic plastic surgery.
After the excision of the scar, triangular flaps are applied at an angle of about 45 ° to the scar. The displacement of the lobe tips results in a Z-shaped scar line, which is closed with fine stitching. Small Z-sculptures are usually performed on an outpatient basis under local anesthesia. This procedure makes scars less noticeable, however, they cannot completely be removed.
Skin transplantation and plastic cloth
Skin sculptures and skin grafts may be required for optimal plastic surgery of larger areas of scar. Frequently, a stay in a clinic is necessary, and depending on the planned surgery general anesthesia may be appropriate. The healing phase can last for several weeks and often supportive bandages and bandages are essential.
The skin grafting involves the removal of healthy skin from a suitable body site to cover the defect of the injured body site. The skin grows at the new site while clogging blood vessels. Skin grafting is associated with the formation of scars at the collection and application areas.
Another complex procedure is the creation of a flap-shaped plastic in individually adapted form. The skin is transplanted with the underlying tissue, if necessary also with muscle tissue, from a healthy body site to cover the injury-related defect. The blood supply of the flap plastic can either be maintained by appropriate local displacement or be ensured by remote use by a simultaneous microsurgical transplantation of blood vessels.
The anesthesia in scar correction
As a rule, scar corrections are made under local anesthesia. Prior to this you will be given, if desired, a sedative, either in the form of a tablet or as an intravenous injection into a vein in the arm, which will put you in a kind of twilight sleep. The patient is awake, but relaxed and painfree. It may be that you occasionally feel a pull or pluck in the operating area during the operation.
If general anesthesia is planned, you will in any case be examined by an anesthesiologist before the operation to clarify your anesthetic ability. Of course, the anesthesiologist is also present during the entire operation and controls and monitors the anesthesia.