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Scars plasty is an operation performed to significantly improve the appearance of scars of various origins.

The healing process of any injury lasts about a year and ends with the formation of a mature scar.

The wounds can be of traumatic and surgical origin.

Surgical wounds heal by primary intention (through surgical sutures) or by secondary intention (without sutures).

In case of surgical treatment of traumatic wounds the latter are transformed into surgical ones and, in the absence of infections and favorable course of wound healing, they also heal by primary intention.

In this case, the healing process goes quickly, with good functional and cosmetic results.

The time of healing and the quality of the scar largely depend on the surgical technique. A seam left by a plastic surgeon heals much faster, doesn’t require removal of sutures and leaves nearly invisible mark on the skin. However, there are a lot of factors related to the individual characteristics of the organism, which greatly affect the process of the scar formation.

According to the characteristics the normotrophic, hypo- and hypertrophic scars can be distinguished. One more scar type is a keloidal scar. Normotrophic scar is formed after proper suturing and wound healing and doesn’t require any correction. All methods of additional treatment in this case are not likely to bring significant results. Even the most well-healed scar can’t totally disappear from the skin.

Hypotrophic scar has a small scar retraction relative to the level of healthy skin. If its width is small, it makes sense to smooth the relief by grinding the edges of the scar. In order to raise its middle part the intradermal fillers can be used. When the width of the scar is more than 3-4 mm, it requires plasty.

The most problematic are hypertrophic and keloidal scars.

In daily life all ugly or rough scars can be called “keloids”. However keloidosis is a serious problem, when mature scars don’t reduce their size, but vice versa, they expand and “capture” healthy skin. This pathology treatment is extremely difficult and sometimes ineffective.

There are several causes of the scar excessive growth. One of the key factors is the location of the scar. In certain places on the body hypertrophy can be observed more often. These places are the sternum, the middle line of the body and the outer surface of the shoulder. The location of the scar along the limb longitudinal axis, especially in the area of joints, can cause contracture, i.e. the restriction of the limb mobility. Such healing conditions as inflammation, the tension of the wound edges, burn wounds, as a rule, lead to a rougher healing.

Hypertrophic and keloidal scarring treatment includes several principles. With a poor healing the repeated intervention is possible only after 6-8 months after the previous surgery or trauma. The base of the operation is the surgical scar removal (excision) and its plasty. During the operation it is necessary to work towards removing the tension and free convergence of the wound edges, in the functionally correct direction for this zone. When suturing wounds the intradermal suture techniques are used that allow reducing the trauma of the wound edges. All that leads to improved conditions for healing.

The process of young scar formation takes place in several stages. In the first 2 months it is important to achieve minimum of mobility and to reduce the load and tension at the edges of the wound. During this period, it is reasonable to wear special handling bandages, compression underwear and to impose limitation on physical activity. By the second month, in the presence of hypertrophic growth the treatment can proceed to the active therapeutic action. The simplest and most effective way is wearing special silicone stickers - adhesive bandages.

The mechanism of therapeutic action is to reduce the cutaneous respiration and skin dehydration in the area of bandage wearing. The effect is visible after a month of continuous bandage wearing. It is especially useful to combine silicone coating with a compression bandage, which creates a constant measured pressure on the area of the scar. Slight compression leads to the compression of the capillaries, which impairs the power of scar tissue, inhibiting its growth. More aggressive hardware method of suppressing the excessive tissue growth is based on sclerosing (gluing) action on the capillaries of certain laser and on the highly intense coherent light (IPL). As a result of capillary surface agglutination the same effect is achieved: the scar tissue trophism is reduced and, consequently, the redness of the scar and its convexity are decreased. Classical methods, such as the introduction of glucocorticoid hormones in the thickness of the scar tissue and radiotherapy are still widely used.

The time of scar tissue maturation may vary. The worse the conditions of wound healing and the lower in the body it is situated, the longer it remains red and the convex. The period of change ends after 6-8 months. In case of hypertrophic growth this period may last for about one year.

The repeated surgical correction is rational only after the completion of the scar formation. Intervention in the active tissues may lead to worse results.

Caring for a young and correctly formed scar is quite simple. A patient must regularly apply skin moisturizers and avoid heavy mechanical loads. But much more important is to know what the patient shouldn’t do. All remedies accelerating the healing process can worsen the outcome of treatment, causing hypertrophy. The same applies to tan. Ultraviolet is a potent stimulator of granulation and scar tissue growth, it is widely used in the treatment of indolent wounds and venous stasis ulcers as it promotes healing. However, with the maturation of the surgical “cosmetic” scar it is better to avoid sunbathing of this area for 5-6 months. Unjustified use of remedies inhibiting the growth of connective tissue may also lead to the expansion and retraction of the surface. Scar treatment should be conducted under the supervision of the plastic surgeon or with their direct participation.

In preparation for the surgery a brief survey is carried out.

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