Elongation of scars associated with the effects of plastic surgery
Last reviewed: 23.04.2024
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Lengthening of scars is necessary in those cases when scars of hypertrophic nature limit movements in the joints and (or) under tension cause unpleasant and even painful sensations. Depending on the degree of shortening of the scar (and, consequently, on the size of its necessary extension), two basic plastic variants are used with counter flaps (Z-plastics). With a relatively small shortening, one-or (with a long scar) a multistage Z-plastic is performed, during which flaps are formed at an angle of about 60 °.
With a significant shortening of the rumen, plastic is performed by four counter-flaps.
The allocated flaps should include the maximum amount of subcutaneous fat, and their base should be represented by normal, scar-unchanged tissue.
Excision of scars. Excision of the scars with subsequent stitching of the edges of the wound is aimed at obtaining a thinner cicatrix and can be performed in three versions: 1) simple excision; 2) creation of a scar duplication; 3) replacement of scar tissue with a full-fledged skin flap.
Excision of the scar is indicated with a relatively small width and with good mobility of the edges of the wound. In this case, after removal of the scar tissue, the edges of the wound are mobilized and, after stopping bleeding, a three-row seam is applied: a deep row (deep layer of the dermis) - a nodal retracted seam with an ethyl (or a proliferation) No. 4/0 - 5/0; middle row - vikrilom No. 5/0 - 4/0 (back nodal suture) and removable (matching) dermo-dermal suture with ethylon No. 4/0.
Creation of the scar duplication is advisable in those cases when the scar has a significant width or is located in a zone with inactive surrounding tissues, as a result of which a considerable tension is created on the seam line.
Operation technique. The scar is not excised, but de-epidermal, dissecting the tissue only along one of its edges. After a sufficiently wide mobilization of the edges of the wound, the first deep seam row is placed between the edge of the de-epidermalized scar and the corresponding tissue site away from the opposite edge of the wound. As a result, the first deep seam line takes on the main load, which allows you to apply a second seam line with little or no tension.
Replacement of scar tissue with a full-fledged skin flap is necessary for extensive scar tissue changes, which results in a significant cosmetic defect and (or) limited movements in the joints of the limb. As a result of excision of scars, a profound tissue defect is formed, which is replaced by a blood-supplying skin-fat or skin-fascial flap (free or not free). One of the variants of this operation is the use of tissue expanders, by means of which the skin area at the site adjacent to the scar-altered tissues is increased. After excision of the last defect of the skin is closed by moving excess skin covering the expander.
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