Skip to main content
SpringerLink
Log in

Scar Revision and Camouflage

  • Chapter
Complications in Cutaneous Surgery

  • 2663 Accesses

Abstract

Despite meticulous planning and technique, suboptimal scars will occur even in the hands of the best surgeons. Skills in scar revision, therefore, are essential to any surgeon’s armamentarium. Preoperatively, patients should be informed that secondary revisions and several stages are always possible, if not probable, with complex reconstructions. An accurate assessment of the scar is a critical first step. In doing so, one should realize that what is wrong to the surgeon may not mirror what is wrong to the patient. Although patient preferences are of utmost importance, they must be balanced with objective findings and what is realistically achievable. Patients must understand that revision procedures are always more difficult and carry no guarantee. This chapter will focus on the range of options for scar revision and its application to surgically induced wounds. Traumatic, inflammatory, and burn scar revisions will not be addressed, although the concepts that will be discussed in this chapter are broadly applicable to scar revision surgery despite the initiating event.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 54.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Teot L. Clinical evaluation of scars. Wound Repair Regen 2002;10:93–97.

    Article  PubMed  Google Scholar 

  2. Rogues C. Massage applied to scars. Wound Repair Regen 2002;10:126–128.

    Article  Google Scholar 

  3. Field T, Peck M, Hernandez-Reif M, Krugman S, Burman I, Ozmen L. Postburn itching, pain, and psychological symptoms are reduced with massage therapy. J Burn Care Rehabil 1999;20:268–271.

    Google Scholar 

  4. Rogues C. Pressure therapy to treat burn scars. Wound Repair Regen 2002;10:122–125.

    Article  Google Scholar 

  5. Kerckhove EV, Stappaerts K, Fieuws S, et al. The assessment of erythema and thickness on burn related scars during pressure garment therapy as a preventive measure for hypertrophic scarring. Burns 2005;31(6):696–702.

    Article  PubMed  Google Scholar 

  6. Chang CH, Song JY, Park JH, Seo SW. The efficacy of magnetic disks for the treatment of earlobe hypertrophic scar. Ann Plast Surg 2005;54:566–569.

    Article  CAS  PubMed  Google Scholar 

  7. Russell R, Horlock N, Gault D. Zimmer splintage: as simple effective treatment for keloids following ear piercing. Br J Plast Surg 2001;54:509–510.

    Article  CAS  PubMed  Google Scholar 

  8. Kerckhove EV, Stappaerts K, Boeckx W, et al. Silicones in the rehabilitation of burns: a review and overview. Burns 2001;27:205–214.

    Article  PubMed  Google Scholar 

  9. Hamanova H, Broz L. Topigel in the treatment of hypertrophic scars after burn injuries. Acta Chir Plast 2002;44:18–22.

    CAS  PubMed  Google Scholar 

  10. Gold MH. A controlled clinical trial of topical silicone gel sheeting in the treatment of hypertrophic scars and keloids. J Am Acad Dermatol 1994;30:506–507.

    Article  CAS  PubMed  Google Scholar 

  11. Borgognoni L. Biological effects of silicone gel sheeting. Wound Repair Regen 2002;10:118–121.

    Article  PubMed  Google Scholar 

  12. Hirshowitz B, Lindenbaum E, Har-Shai Y, Feitelberg L, Tendler M, Katz D. Static-electric field induction by a silicone cushion for the treatment of hypertrophic and keloid scars. Plast Reconstr Surg 1998;101:1173–1183.

    Article  CAS  PubMed  Google Scholar 

  13. Berman B, Flores F. Recurrence rates of excised keloids treated with postoperative triamcinolone acetonide injections or interferon alfa-2b injections. J Am Acad Dermatol 1997;37:755–757.

    Article  CAS  PubMed  Google Scholar 

  14. Granstein RD, Rook A, Flotte TJ, et al. A controlled trial of intralesional recombinant interferon-gamma in the treatment of keloidal scarring. Clinical and histologic findings. Arch Dermatol 1990;126:1295–1302.

    Article  CAS  PubMed  Google Scholar 

  15. Larrabee WF, East CA, Jaffe HS, Stephenson C, Peterson KE. Intralesional interferon gamma treatment for keloids and hypertrophic scars. Arch Otolaryngol Head Neck Surg 1990:116:1159–1162.

    PubMed  Google Scholar 

  16. Broker BJ, Rosen D, Amsberry J, et al. Keloid excision and recurrence prophylaxis via intradermal interferon-gamma injections: a pilot study. Laryngoscope 1996;106:1497–1501.

    Article  CAS  PubMed  Google Scholar 

  17. Kaufman J, Berman B. Topical application of imiquimod 5% cream to excision sites is safe and effective in reducing keloid recurrences. J Am Acad Dermatol 2002;47:S209–S211.

    Article  PubMed  Google Scholar 

  18. Berman B, Villa A. Imiquimod 5% cream for keloid management. Dermatol Surg 2003;29:1050–1051.

    Article  PubMed  Google Scholar 

  19. Jacob SE, Berman B, Nassiri M. Topical application of imiquimod 5% cream to keloids alters expression genes associated with apoptosis. Br J Dermatol 2003;149(Suppl 66):62–65.

    Article  CAS  PubMed  Google Scholar 

  20. Ketchum LD, Smith J, Robinson DW, Masters FW. The treatment of hypertrophic scar, keloid scar and scar contracture by triamcinolone acetonide. Plast Reconstr Surg 1996;38:209–218.

    Google Scholar 

  21. Kelly PA. Medical and surgical therapies for keloids. Dermatol Ther 2004;17:212–218.

    Article  PubMed  Google Scholar 

  22. Giovannini UM. Treatment of scars by steroid injections. Wound Repair Regen 2002;10:116–117.

    Article  PubMed  Google Scholar 

  23. Fitzpatrick RE. Treatment of hypertrophic scars using intralesional 5FU. Dermatol Surg 1999;25:224–232.

    Article  CAS  PubMed  Google Scholar 

  24. Apikian M, Goodman G. Intralesional 5-fluorouracil in the treatment of keloid scars. Australas J Dermatol 2004;45:140–143.

    Article  PubMed  Google Scholar 

  25. Nanda S, Reddy BSN. Intralesional 5-fluorouracil as a treatment modality for keloids. Dermatol Surg 2004;30:54–57.

    Article  PubMed  Google Scholar 

  26. Rusciani L, Rosse G, Bono R. Use of cryotherapy in the treatment of keloids. J Dermatol Surg Oncol 1993;19:529–534.

    CAS  PubMed  Google Scholar 

  27. Ceilley RI, Barin RW. The combined use of cryosurgery and intralesional injections of suspension of fluorinated adrenocorticosteroids for reducing keloids and hypertrophic scars. J Dermatol Surg Oncol 1979;5:54.

    CAS  PubMed  Google Scholar 

  28. Garg MK, Weiss P, Sharma AK, et al. Adjuvant high dose rate brachytherapy (Ir-192) in the management of keloids which have recurred after surgical excision and external beam radiation. Radiother Oncol 2004;73:233–236.

    Article  PubMed  Google Scholar 

  29. Guix B, Henriquez I, Andres A, et al. Treatment of keloids by high-dose brachytherapy: a seven year study. Int J Radiat Oncol Biol Phys 2001;50:167–172.

    CAS  PubMed  Google Scholar 

  30. Clavere P, Bedane C, Bonnetblanc JM, Bonnafoux-Clavere A, Rousseau J. Postoperative interstitial radiotherapy of keloids by iridium 192: a retrospective study of 46 treated scars. Dermatology 1997;195:349–352.

    Article  CAS  PubMed  Google Scholar 

  31. Alster TS. Improvement of erythematous and hypertrophic scars with 585 nm flashlamp pulsed dye laser. Ann Plast Surg 1994;32:186–190.

    Article  CAS  PubMed  Google Scholar 

  32. Alster TS, Williams CM. Improvement of keloid sternotomy scars by the 585 nm pulsed dye laser: a controlled study. Lancet 1995;345:1138–1200.

    Article  Google Scholar 

  33. McCraw JB, McCraw JA, McMellin A, Bettencourt N. Prevention of unfavorable scars using early pulse dye laser treatments: a preliminary report. Ann Plast Surg 1999;42:7–14.

    Article  CAS  PubMed  Google Scholar 

  34. Nouri K, Jimenez GP, Harrison-Balestra C, Elgart GW. 585 nm pulsed dye laser in treatment of surgical scars starting on the suture removal day. Dermatol Surg 2003;29:65–73.

    Article  PubMed  Google Scholar 

  35. Katz BE, Oca AG. A controlled study of the effectiveness of spot dermabrasion (“scarabrasion”) on the appearance of surgical scars. J Am Acad Dermatol 1991;24:462–466.

    Article  CAS  PubMed  Google Scholar 

  36. Yarborough JM Jr. Ablation of facial scars by programmed dermabrasion. J Dermatol Surg Oncol 1988;14:292–294.

    PubMed  Google Scholar 

  37. Nehal KS, Levine VJ, Ross B, Ashinoff R. Comparison of high-energy pulsed carbon dioxide laser resurfacing and dermabrasion in the revision of surgical scars. Dermatol Surg 1998;24:647–650.

    Article  CAS  PubMed  Google Scholar 

  38. Tanzi EL, Alster TS. Treament of atrophic facial acne scars with dual-mode Er:YAG laser. Dermatol Surg 2002;287:551–555.

    Article  Google Scholar 

  39. Ammirati CT, Cottingham TJ, Hruza GJ. Immediate postoperative laser resurfacing improves second intention healing on the nose: 5 year experience. Dermatol Surg 2001;27:147–152.

    Article  CAS  PubMed  Google Scholar 

  40. Davidson TM, Horlbeck DM. The geometric broken line technique. In: Harahap M, ed. Surgical techniques for cutaneous scar revision. New York: Marcel Dekker; 2000:407–423.

    Google Scholar 

  41. Lee KK, Mehrany K, Swanson NA. Surgical revision. Dermatol Clin 2005;23:141–150.

    Article  PubMed  Google Scholar 

  42. Onizuka T, Ohkubo F. The W-plasty technique. In: Harahap M, eds. Surgical techniques for cutaneous scar revision. New York: Marcel Dekker; 2000:397–405.

    Google Scholar 

  43. Rodgers BJ, Williams EF, Hove CR. W-plasty and geometric broken line closure. Facial Plast Surg 2001;17:239–244.

    Article  CAS  PubMed  Google Scholar 

  44. Frodel JL, Wang TD. Z-plasty In: Swanson NA, Baker SR, eds. Local flaps in facial reconstruction. St. Louis: Mosby; 1995:131–149.

    Google Scholar 

  45. Rohrich RJ, Zbar Ross IS. A simplified algorithm for the use of Z-plasty. Plast Reconstr Surg 1999;203:1513–1518.

    Google Scholar 

  46. Furnas DW, Fischer GW. The Z-plasty: biomechanics and mathematics. Br J Plast Surg 1971;24:144–160.

    Article  CAS  PubMed  Google Scholar 

  47. Seno H, Yanai A, Hirabayashi S. The Z-plasty technique. In: Harahap M, eds. Surgical techniques for cutaneous scar revision. New York: Marcel Dekker; 2000:381–395.

    Google Scholar 

  48. Johnson SC, Bennett RG. Double Z-plasty to enhance rhombic flap mobility. J Dermatol Surg Oncol 1994;20:128–132.

    CAS  PubMed  Google Scholar 

  49. Orentreich DS, Orentreich N. Subcutaneous incisionless (Subcision®) surgery for the correction of depressed scars and wrinkles. In: Harahap M eds. Surgical techniques for cutaneous scar revision. New York: Marcel Dekker; 2000:245–257.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Dermatology and Otorhinolaryngology, M. D. Anderson Cancer Center, University of Texas, Houston, TX, USA

    Tri H. Nguyen MD (Associate Professor)

Authors
  1. Tri H. Nguyen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Dermatology, University of Cincinnati, Cincinnati, Ohio, USA

    Hugh M. Gloster Jr. MD (Associate Professor and Director of Dermatologic Surgery) (Associate Professor and Director of Dermatologic Surgery)

Rights and permissions

Reprints and permissions

Copyright information

© 2008 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Nguyen, T.H. (2008). Scar Revision and Camouflage. In: Gloster, H.M. (eds) Complications in Cutaneous Surgery. Springer, New York, NY. https://doi.org/10.1007/978-0-387-73152-0_10

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-73152-0_10

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-73151-3

  • Online ISBN: 978-0-387-73152-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation