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Lengthening of scars associated with the consequences of plastic surgery
Last reviewed: 04.07.2025
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Scar elongation is necessary in cases where hypertrophic scars limit joint movement and/or when stretched are the cause of unpleasant and even painful sensations. Depending on the degree of scar shortening (and, consequently, on the amount of necessary elongation), two main variants of plastic surgery with counter flaps (Z-plasty) are used. In case of relatively small shortening, one-stage or (in case of a long scar) multi-stage Z-plasty is performed, during which flaps are formed at an angle of about 60°.
If the scar is significantly shortened, plastic surgery is performed using four opposing flaps.
The allocated flaps should include the maximum amount of subcutaneous fat, and their base should be represented by normal, scar-unaltered tissue.
Scar excision. Scar excision with subsequent suturing of the wound edges is aimed at obtaining a thinner scar and can be performed in three variants: 1) simple excision; 2) creation of a scar duplication; 3) replacement of scar-altered tissues with a full-fledged skin flap.
Excision of the scar is indicated when it is relatively narrow and the wound edges are mobile. In this case, after removal of the scar tissue, the wound edges are mobilized and after bleeding has stopped, a three-row suture is applied: deep row (deep layer of the dermis) - interrupted non-removable suture with etilon (or prolene) No. 4/0 - 5/0; middle row - vicryl No. 5/0 - 4/0 (reverse interrupted suture) and a removable (matching) dermo-dermal suture with etilon No. 4/0.
Creating a scar duplication is advisable in cases where the scar is of significant width or is located in an area with low-mobility surrounding tissues, resulting in significant tension being created on the suture line.
Technique of the operation. The scar is not excised, but de-epidermized, cutting the tissues along only one of its edges. After a sufficiently wide mobilization of the wound edges, the first deep row of sutures is applied between the edge of the de-epidermized scar and the corresponding area of tissues away from the opposite edge of the wound. As a result, the first deep line of sutures takes on the main load, which allows the second line of sutures to be applied with virtually no tension.
Substitution of scar-altered tissues with a full-fledged skin flap is necessary in case of extensive scar tissue changes, which result in a significant cosmetic defect and/or limitation of joint movements in the limb. Scar excision results in a deep tissue defect, which is replaced with a blood-supplied skin-fat or skin-fascial flap (free or non-free). One of the options for this operation is the use of tissue expanders, which are used to increase the area of skin in the area adjacent to the scar-altered tissues. After excision of the latter, the skin defect is closed by moving the excess skin covering the expander.
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