Anlaysis of Scar Revision

Jeyakumar, P (2007) Anlaysis of Scar Revision. Masters thesis, Stanley Medical College, Chennai.


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INTRODUCTION: Scar is defined as the trace of healed wound, sore or burn. A fault or blemish remaining as a trace of some former condition or resulting from some particular cause. In Medical Terminology, a scar is non regenerative wound Healing. Preferred scar is the one that has matured early without contraction or increase in width, formation of collagen that is not more than necessary for its strength. Scar Revision is a commonly requested procedure that is performed frequently by the majority of plastic surgeons. The holistic approach to the patient is paramount in scar revision. Scar revision is a process that requires careful assessment, technical expertise and recognition of the underlying psychosocial issues if a satisfactory outcome is to be achieved. Each patient is different and it is in appropriate simply to select standard operation. AIM OF THE STUDY: The aim of the study is to analyse the causes of scar which include Road Traffic Accidents, Assault, Burns, Chronic infections & Acne, • To analyse the reasons for scar revision with include - functional aesthetic, psycholgoical problems. • To discuss medical / surgical treatment options. • To assess the scar post operatively using Beausang's clinical score and subjective patient acceptance. • To find out incidence of reference from doctors. • To find out Technical differences in the procedure in our set up. MATERIALS AND METHODS: 25 patients of facial scars of varied etiology were taken up for study in the period of 2½ years from August 2005 March 2007. 10 female patient, 15 male patients. Average age group 15-25 years almost all are in same age group. Etiology of Scar: Assault - by knife – 6, Road Traffic accidents – 9, Burns – 6, Others – 4. No. of patients referred by medical professionals – 6, Self referral – 19. All patients underwent scar revision surgery, assesed by Beansang;s clinical score - post operatively. Procedure done are linear excision + closure – 12. `Z' plasty – 6, `W' plasty -2, serial Excision – 4, Tissue expansion – 1, Post operative score - 12 patients - score of 8-9, 8 patient - score of 10-12, 4 patients – 13, 1 patient – 14. 5 patients were not satisfied with result. 20 patients were satisifed. Operative Procedure : Elliptical Closure All cases are done under local infiltration anaesthesia - except one cast of tissue expansion of neck -which was done order GA. 1% xylocaine with adrenaline is used.  Areas cleaned, draping done.  Scar markings dones before infiltration.  Local infiltration anasthesia given.  Scar is excised. Skin flaps undermined, and especially at corners. Hemostasis obtained with bipolar diathermy Dermal subdermal sutures applied with 4-0 prolene Skin sutured with either simple sutures using 5-0 prolene or subcuticular suture were 3-0 nylon. Compression dressing given. Post op.followup. Wound inspected after 48 hrs - left opened after 48 hours. Suture removal of 6th day. After 3 weeks scar massage. Aloevera cream applied two times a day. Scar assessed after 4 weeks / 3 / and 6 months. OUTCOME OF THE STUDY: 1. Most of the patients came for scar revision in the age group of 15-30 years - especially they came for scar treatement when they are preparing for marriage. All the patients have thought that after plastic surgery treatment there will be no scars. 2. Most of the patients came for oesthetic reasons only Functional problems like painful scar / or contour deformity in face relatively rare. 3. Most of the scars due to Assault with knife, Road traffic accidents, burns. 4. After surgical revision most of the patients (18/25) were satisfied with the result. 5 patients were not satisfied. Of the 5, 2 patients developed scar contracture and bad result. 5. Medical treatment will be useful in superfical scars, and for prevention a severity and scar. 6. Post operative Beausang's score - 12 patients score - 8-9, 8 patients score - 10-11, 3 Patients score - 13, 2 Patients score - 14, 7. Reference from primary physicians to specialist for scar management is compartively less. 8. Using various techniques like `Z' plasty or `W' plasty, depends upon location and scar, direction of scar relate to RSTL - if used properly gives good results. 9. Scar revision in post traumatic scar gives good results than post burn scar CONCLUSION:  People have myth that after scar revision by plastic surgeons, they won't have any scar, but that is not true. Always there will be remaining scar. When we explained these to patients, 10% of patients - refused surgery.  Z Plasty in face - size of the `Z' is not more than 3mm, so that scar size will not increase.  Dermo epidemal suture using 4-0 prolene gives consistantly good results.  Scar revision post traumatic scar gives better result them post burn scar.  Dermabrasion will not be useful in post burn scar due to absence of dermis.  `W' plasty - used in face especially forehead, cheek where limbs of `W' runs parrells to reliving skin tension lines.  `Z ' plasty we used whenever there is need for lengthening of scar, to break it small segments also to get along the RSTL lines.  Post operative application of Allovera gel alongwith scar massage significantly reduces scar severity.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Scar Revision ; Anlaysis.
Subjects: MEDICAL > Plastic and Reconstructive Surgery
Depositing User: Kambaraman B
Date Deposited: 12 Oct 2017 01:48
Last Modified: 12 Oct 2017 01:48

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