● Common and disturbing scars
1. The facial scar is located near the five senses, which leads to the deformation or function limitation of the five senses, such as the corners of the eyes and corners of the mouth.
2. The scar on the joints of the limbs leads to limited activities.
3. Long and wide scars.
4. Hypertrophic raised scars.
5. A sunken and wrinkled scar.
6. Pigmented or prominent scars do not match the color of the nearby skin.
7. Scars that don't match the texture of the surrounding skin.
8. Scars with obvious discomfort symptoms, such as itching, burning pain or surface ulcers.
● Scar prevention
1. The first step to prevent scars is correct wound care. Whether it is trauma, scald, skin infection or surgery, scars will be produced after wound healing. Proper wound care can avoid abnormal scars.
2. After the stitches are removed or the wound is initially healed, massage therapy and compression therapy are started as appropriate.
3. Stick the cosmetic tape or silicone sheet on the healed wound. It takes 24 hours to stick the beauty tape firmly, and it takes about 12 hours to stick the silicone sheet. The scope of application must be larger than the wound itself and include the surrounding normal skin.
4. Compression therapy can reduce the outward stretching force of the wound and make the scar flatter and thinner.
5. Massage therapy can soften hard scars, have the function of tissue expansion, and can improve bulges or scars with contracture tendency.
6. For a large area of wound, you can consider the compression treatment method of tight elastic clothes.
● Preoperative preparation and related consultation.
1. Unless only superficial epidermis is injured, most skin injuries or surgical incisions will cause healing scars to varying degrees.
2. Once you have a scar, you will have a lifelong scar. So far, the medical community has not been able to completely eliminate this scar. Now all the operations, drugs and lasers can't make the scar disappear, but a certain degree of improvement can be done. Especially through the skillful hands of plastic surgeons, I hope to satisfy patients.
3. Once there is a scar, the plastic surgeon can only' trim' the scar but not' eliminate' it, so as to minimize the interference to his daily life and give consideration to the requirements of functional reconstruction and aesthetic improvement.
4. Scars with limited motor function must be treated surgically as soon as possible to avoid permanent joint function damage.
5. Unpleasant scars can usually be considered from three aspects, namely, the size of the area, the degree of uplift and depression, and the depth of color.
6. A small area of scar can be surgically removed, carefully sutured, and combined with some trimming operations, so that the wound healing can be completed with minimum tissue tension, and the scar can be made into a linear scar.
7. If the scar is too large, it may need to be removed many times, accompanied by complicated operations such as local flap or distal flap.
8. The process of scar formation can be roughly divided into three stages, namely, inflammatory reaction stage, fibrous hyperplasia stage and mature stage. Usually, before it is mature, many preventive measures can be taken to reduce the appearance of ugly scars. Therefore, it is recommended to carry out scar repair surgery, preferably after the scar has matured, and the effect of wound formation is remarkable for about half a year.
9. It is often seen that some people's scars reappear after surgical resection for a period of time, and it is more obvious than before, indicating that this person is prone to "crab feet swelling" and is not suitable for surgical treatment.
10. How to distinguish "swollen crab feet" from "hypertrophic scars" must be judged by plastic surgeons.
● Treatment of scar: It can be divided into three categories:
The first category: ※:
1. Compression therapy: put a cosmetic adhesive tape on the scar and massage it hard at a fixed point to make the scar smooth gradually. This method must last for more than 6 months to be effective.
2. Silicone patch sticking method: stick a silicone patch on the scar for eight hours on the first day, and it can be increased to 12 hour after the skin gradually adapts, and the effect is good for six months. As for the mechanism of action of silica gel tablets, Quinn thinks that it is the chemical action of continuous release of silica gel, and Swada and Son think that it is the physiological action of hydration and occlusion that causes scar inhibition. PS。 The above item 1.2 is applicable to those with scars less than half a year.
3. Inject steroids into the scar: Inject long-acting steroids directly into the scar to inhibit excessive collagen in the scar, thus achieving the effect of inhibiting the scar.
Ketchum suggested dose:
Maximum dose/frequency of administration
Adult 120mg, injected/kloc-0 once a month for 4 ~ 6 months.
1-5 years old children 40mg
6- 10 years old 80mg.
4. Radiation: In the past, radiation was used to kill, inhibit or transform into fibroblasts to control the excessive proliferation of scar tissue. At present, this method paper is reserved for large-scale crab foot swelling patients who are ineffective in steroid treatment.
5. Others: The methods mentioned in the literature that can inhibit scars are:
O vitamin a
O vitamin e
Inhibit collagen, such as BAPN(β- aminopropionitrile), penicillamine and colchicine.
O inhibition of asiaticoside in muscle fiber cells during swelling of crab feet
Zinc oxide (zinc oxide)
O antineoplastic agents: such as methotrexate (MTX)
O immunotherapy: such as interferon and TGF-B inhibitor.
The second type: laser. ※
According to the principle of laser scar removal, it can be divided into two types:
O A-type dermabrasion laser can be divided into CO2 laser and Er-YAG laser, which can smooth scar bulge, and superficial sunken scar can also use this principle.
O Depigmented laser: It can be divided into dye laser and pulsed intense light (photoderm). The laser acts on the blood vessels and heme in the scar, which makes the color of the scar fade and shrink gradually. This kind of laser is especially suitable for people who have been scarred for less than half a year and have dark colors.
The third type: operation. ※
When the scar has been stable (usually the scar has been formed for more than half a year) and the appearance is wide, thick or indecent, surgery should be used to control the scar. Surgical methods include scar excision, re-sewing, Z-shaped or W-shaped scar repair, dermabrasion and so on. If the scar is too big, you can consider removing it by stages or placing a tissue expander for a period of time before removing the scar.
Communication of scar concepts
1. Scar prevention is better than scar treatment.
2. The more serious the wound, the stronger the inflammatory reaction, and the more obvious the scar formed in the future, such as after burns and scalds, such as after severe limb crush injuries.
3. If the wound after trauma is infected and inflamed repeatedly, the scar after healing will be more obvious.
4. It is best to reduce the activity of the wound after operation, otherwise it will affect the wound healing and stimulate the formation of scars, which is also the reason why the scars at the joints of limbs are usually obvious.
5. The younger the skin, the thicker, redder and harder the scar is due to its strong elasticity and tension, and the scar gradually fades. In older people, because of the opposite conditions, the epidermal tension is relaxed and the scar is less obvious.
6. Postoperative wounds must be well cared for, stitches removed in time, avoiding sun exposure and using cosmetics or skin care products to reduce pigmentation and scar irritation.
7. After the operation, in order to avoid bad scars, appropriate pressure massage is needed, or oppressive adhesive (such as the most widely used paper tape or silicone sheet) is used, but excessive force is not allowed to split the wound.
8. The actual effect of advertising materials on the market-quba ointment or secret herbs has yet to be verified by clinical medicine. Please be careful!
9. Scar refers to the product of skin wound healing caused by trauma or surgery, which will always exist on the skin and is difficult to remove by external force. Through scar treatment and other methods, uneven or rough scars can be beautified into small, plain and difficult to see scars, but they cannot be removed.
10. The correct term for scar treatment should be' scar repair', not' scar removal'.