Scar Revision Surgery
A scar is a mark left after a wound has healed. Scar revision surgery can help improve the look of a scar or make it less visible. It can make it thinner, or less raised. If the scar is tight and restricts movement of the skin, revision can improve this. No scar can be completely erased. But scar revision surgery can help a scar look and feel better.
Types of surgery
Scar revision surgery can be done in a number of ways. The method used depends on the type of scar you have and where it is on your body. You and your healthcare provider will discuss these details before the surgery. Common methods of scar revision surgery include:
Excision. The scar is surgically removed, and the area closed with sutures.
Skin graft. Scar tissue is removed. It is then replaced with a piece of healthy skin (graft) taken from another part of the body.
Z-plasty. A Z-shaped incision is made through the scar tissue and some healthy skin. (If the scar is very large, more than one incision may be made.) The Z-shape creates pointed skin flaps that can then be arranged for a more pleasing look and contour.
Preparing for surgery
Prepare for the surgery as you have been told. In addition:
Tell your healthcare provider about all medicines you take. This includes herbs and other supplements. It also includes any blood thinners, such as warfarin, clopidogrel, or daily aspirin. You may need to stop taking some or all of them before surgery.
Follow any directions you are given for not eating or drinking before surgery.
The day of surgery
The surgery takes 2 to 4 hours. You may go home the same day. Or you may stay 1 or more nights.
Before the surgery begins
An IV line is put into a vein in your arm or hand. This line delivers fluids and medicines.
You will be given medicine (anesthesia) to keep you pain free during the surgery. You may receive sedation, which makes you relaxed and sleepy. Local anesthesia also used to numb the surgical area. In certain cases, general anesthesia is used instead. This puts you into a state like deep sleep during the surgery. With general anesthesia, a tube may be inserted into your throat to help you breathe. The anesthesiologist will discuss your options with you.
During the surgery
Your healthcare provider will repair the scar using the method discussed with you before the surgery.
You will be taken to a recovery room to wake up from the anesthesia. You may be sleepy and nauseated. If a breathing tube was used, your throat may be sore at first. You will be given medicine to manage pain. If the revision is to a large area, you may stay one or more nights in the hospital. Once you are ready to go home, have an adult family member or friend drive you.
Recovering at home
Once at home, follow the instructions you have been given. Your healthcare provider will tell you when you can return to your normal routine. To help your healing:
Take any prescribed medicines exactly as directed.
If advised by your healthcare provider, use a cold pack wrapped in a thin towel to relieve discomfort and control swelling. It’s important not to leave the cold pack on for too long, or your skin could be damaged. Put the pack over your bandages for no more than 10 minutes at a time. Then, leave it off for at least 20 minutes. Repeat this as often as needed during waking hours until swelling starts to improve. Don’t fall asleep with the cold pack on. If you’re not sure how to safely use the cold pack, ask your healthcare provider.
Follow all instructions from your healthcare provider for taking care of the incision. Leave the bandage in place until you are told to remove or change it. Once you can change your bandage, do so every 24 hours or as directed. Also replace the bandage whenever it gets wet or dirty. Wash your hands before changing the bandage.
Keep the surgical site clean and dry. You can get it wet after 48 hours. Rinse the surgical site gently and pat it dry.
Keep the surgical site out of the sun as it heals. This will help ensure a better outcome. At first, cover the healing skin with a bandage or clothing. When your healthcare provider says it’s OK, you can use sunscreen on the site.
When to call your healthcare provider
Call your healthcare provider if you have any of the following:
Chest pain or trouble breathing (call 911)
A fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider
Symptoms of infection at an incision site, such as increased redness or swelling, warmth, worsening pain, or foul-smelling drainage
Bleeding or drainage from the incision
Pain that is not relieved by medicine
You will have follow-up visits so your healthcare provider can see how well you’re healing. During these visits, your healthcare provider can monitor the results of your surgery. Let your healthcare provider know if you have any questions or concerns.
Risks and complications
Risks and possible complications include:
Blood clots, which can travel to the lungs, heart, or brain
Damage to nerves, muscles, or blood vessels
Changes in skin sensitivity
Not liking look of revised scar
Recurrence of a keloid scar
Risks of anesthesia. The anesthesiologist will discuss these with you.
November 06, 2017
Principles of grafts and flaps for reconstructive surgery. Up To Date, Z-plasty. Up To Date
Fraser, Marianne, MSN, RN,Lickstein, David, MD