A scar is a mark that represents a wound to the skin. This kind of trauma may be caused by trauma or it may be necessary for surgery. However, due to the different degree of trauma, whether the healing process is smooth or not, the position of the wound on the human body is different, and the size is also obviously different. Especially with the progress of modern society, the love of beauty not only represents a right, but also embodies a kind of self-esteem. Scar is one of the most common problems in cosmetic surgery clinic. In addition to the appearance, in fact, many scars can cause uncomfortable itching, pain and chapping. If the scar contracture is unfortunate, it will not affect the normal function of limbs or five senses. These scars must be treated actively.
● 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'.
Overview of scar
First, the concept of pathological scar
Pathological scar, also called abnormal scar, is relative to normal scar. Hypertrophic scar (HS) and keloid (K) are collectively called pathological scar. Scars with similar texture to the surrounding skin are called normal scars or mature scars. Pathological scar is a kind of skin fibrosis disease, which has excessive production and deposition of a large number of connective tissue matrix such as collagen.
Second, the importance and harmfulness of scars
Scar is an inevitable product in the process of human wound repair. Broadly speaking, there is no wound healing without scars. The main component of scar tissue is fibrin. The production and deposition of collagen in scar tissue increases the strength of the wound, which is beneficial in general. If the scar tissue is not completely formed, the damaged tissue can't get normal tension, which will lead to many complications, such as the scar healed by abdominal incision is weak, and under the action of intra-abdominal pressure, the scar can be re-opened or the abdominal contents gradually swell out, forming abdominal hernia. On the contrary, if the scar is excessively formed, it will always lead to serious appearance or function problems. The harm of scar depends on its essence and characteristics, as well as its secondary fixation of deep tissue. Therefore, compared with the tissue before injury, scar is always an imperfect substitute. From the mechanical point of view, its strength resistance is weakened; From the point of view of nutrition, it creates obstacles to the exchange of oxygen and nutrients; Functionally, it causes deformity and dysfunction of damaged tissues, and aesthetically, it destroys the appearance.
Third, the clinical manifestations and classification of scars
According to histological and clinical differences, scars can be divided into the following types:
Hypertrophic scar
This kind of scar mostly occurs after deep burn wounds heal. Reticular hypertrophic scar is also common in the suture around the third-degree burn wound after skin grafting. In addition, the most common is that any scar after suture also belongs to this category.
Hypertrophic scar is characterized by prominent surface, irregular shape, unevenness, flushing and congestion, and tough texture. There is burning pain and itching. Hypertrophic scar is characterized by rising ambient temperature, emotional excitement, or aggravated symptoms when eating spicy and irritating food. Hypertrophic scars usually last for months or years before they gradually degenerate. This kind of scar is characterized by early local swelling, hardening and congestion. The surface of its tissue structure is covered by a layer of atrophic epithelial cells, with vasodilation and inflammatory cell infiltration in the middle layer, less collagen fibers in the bottom layer and a large number of connective tissue hyperplasia. This kind of scar is higher than the skin surface, and it thickens and hardens locally in the early stage. The capillaries are red or dark red with congestion. Generally, the base of scar is not attached to deep tissue, so it can be pushed and squeezed, and its contractility is small. Most of them will not cause serious dysfunction, but it will affect the beauty of face and exposed parts, so it often needs treatment.
Second keloid
Keloid is essentially a connective tissue tumor on the skin, and it is a kind of scar characterized by continuous and powerful proliferation. It is often manifested as the image of crab feet infiltrating into the surrounding healthy skin, and the skin lesions protrude out of the skin, uneven, irregular, hard and tough. I feel itchy and unbearable.
Characteristics of keloid:
1. System factors may play a major role, especially specific physical factors, which sometimes show genetic characteristics. Keloid of this kind of patients often has no obvious relationship with the severity of skin injury. Even small trauma, such as mosquito bites, vaccination and other acupuncture injuries, can form keloid.
2. Racial differences: According to statistical analysis, the incidence of keloid in people with darker skin color is 6-9 times higher, which may be related to abnormal metabolism of melanocyte stimulating hormone.
3. Significant predilection sites: common in sternum, deltoid muscle, auricle, mandible and upper back.
4. The lesion is very long and grows for many years. With the progress of the lesion, the scar gradually infiltrated and spread beyond the original basement and spread to the surrounding normal skin.
5. It is easy to relapse after simple surgical resection and suture treatment, and the stronger the proliferative power, the larger the scar area and the faster the growth rate. Therefore, arbitrary surgical resection is not allowed.
Keloid is common in the upper neck, ears, chest, shoulders and upper arms. Female sternum is the most common part, which is related to the weight pulling and breathing movement of both breasts.
At present, the etiology of keloid is unknown, which may be related to the special qualities of human beings, that is, the so-called scar constitution. In addition, chronic infection and chemical stimulation are also factors that cause pain. In addition, it is also related to family inheritance.
Three superficial scars
This refers to a kind of scar on the surface of skin, which is mostly caused by slight skin abrasion or superficial burn (superficial dermis). Its appearance is slightly different from that of normal skin, with rough surface or pigment changes, and generally no dysfunction. As time goes on, scars will gradually become inconspicuous, so this kind of scar generally does not need treatment.
Four atrophic scars
It is the most unstable scar tissue, also known as unstable scar. It is common in large-area burns, especially wounds that go deep into the fat layer, and heal through the growth of surrounding epithelial cells without skin grafting. ; In addition, the healing of chronic ulcers in the lower leg or other parts after long-term treatment is also a scar of this nature. This kind of scar is characterized by thin epidermis, flat surface, poor local blood circulation, bright white and hard base. Because its surface layer is only covered with a layer of atrophic epithelial cells, it can not withstand external friction, and it is often easy to rupture and form ulcers, which is generally difficult to heal and can lead to malignant transformation for a long time. Therefore, it is a kind of scar that often adheres to the underlying muscles, nerves and blood vessels, and has great contractility, so it can stretch normal tissues, causing more serious dysfunction than hypertrophic scars.
Because this kind of scar is very destructive, we should pay attention to prevention, transplant skin as soon as possible, and don't let it heal itself.
Five contracture scars
Contraction scar is a kind of scar named after its dysfunction. It is more common after deep burn healing. Because of scar contraction, it often leads to appearance change and dysfunction. Long-term scar contracture will affect the development of bones, muscles, blood vessels, nerves and other tissues, and should be treated as soon as possible. The common deformities caused by scar contracture in clinic include ectropion of eyelid, ectropion of lip, chin-chest adhesion, scar contracture of hand and flexion or extension contracture of each joint. Among them, the cord-like scar contracture of the flexion surface of the joint, if it takes a long time, the skin and subcutaneous tissue on both sides of the contracture scar can be gradually elongated and become webbed scar contracture, which is called webbed contracture scar. This kind of reticular scar is common in the front of neck, armpit, elbow fossa, ankle joint and so on. The smaller ones can be found in inner canthus, outer canthus, nasolabial groove, squab, webbed fingers and other parts, and some appear in a ring shape at the opening of body surface pores, which leads to the narrowing of its caliber and affects its normal function. Reticular contracture scar can be repaired by Z plasty.
Six sunken scars
When scar tissue causes concave deformity of body surface, it is called concave scar. It is common in scars left after smallpox, chickenpox or acne, and can also be seen in patients with trauma and skin infection. Simple concave scars are only linear scars and depressions in their areas, while extensive concave scars can be combined with subcutaneous tissue, muscle or bone tissue defects. The scar base is attached to the deep muscle or tendon. To correct this deformity, we should not only deal with the scar on the skin, but also adopt different methods to repair the defect and restore the normal appearance according to the degree of depression.
Seven kinds of scar cancer
Scar tissue can be malignant and become scar cancer. Scar cancer mostly occurs in contracture scars formed by burns. It often occurs in the adjacent parts of joints. Because of the constant pulling of joint activity, the scar breaks repeatedly and eventually becomes cancerous. Scar cancer can also originate from the scar tissue of chronic ulcer of lower limbs or the sinus of chronic osteomyelitis. Scar cancers are mostly fully differentiated squamous cell carcinomas. Lymphatic metastasis is the main form, while hematogenous metastasis is rare.
Comprehensive therapy of traditional Chinese medicine: the first step: inhibiting the growth of fibroblasts.
Step 2: Dissolve fibrous connective tissue.
Step 3: After the acne is calmed down, repair the scars and pigmentation. Step 4: block the growth path of keloid.
After a course of treatment with compound acne Li Xiao, the effect is obvious. 2-3 courses of treatment are completely cured! ! ! ! !
Self-care of scars
In daily life, if you are accidentally scalded or burned by water, fire, oil, etc. If the area is not large, you can immediately take 1 part of white sugar and 3 parts of cold boiled water to make concentrated sugar water, and gently apply cotton wool or clean towel dipped in sugar water to press the injured part. If your fingers or toes are injured, immediately soak them in sugar water for 20 minutes. If it is too late to adjust the sugar water, you can also grab some sugar and apply it to the wound, then drop it on the sugar with cold water to make the wound moist, and then wash it after 2 hours. If it has not healed, you can apply it with concentrated sugar water. Treating burns with sugar water has a good effect without blisters and scars.
First, remove the heat source and soak the limb in cold water until the pain disappears. You can also cover the wound with a wet towel or sheet and spray cold water on it. Don't burst the bubble.
Scalds can be divided into first-degree burns (erythema, skin redness and burning pain), second-degree burns (blisters and blisters in the affected area) and third-degree burns (necrosis and skin peeling). For a small area of mild burns, they can be treated at home. After cleaning the wound, Jing Wanhong and Bao Mei Run Burn Ointment can be applied externally. For large-area burns, it is advisable to send them to the hospital as soon as possible. The treatment of scald is the most important. First, shave the hair around the injured area and cut off the long nails. Wash the healthy skin around the wound with soapy water and clean water, and then scrub and disinfect it with 0. 1% bromogeramine solution or 75% alcohol. Rinse the wound with isotonic saline, remove foreign bodies and dirt from the wound, protect the small blisters from being punctured, and use an empty needle to extract the blood bubble fluid from the big blisters. If the blister is broken or seriously polluted, cut off the blister, gently roll it with gauze, cover it with a layer of liquid paraffin gauze or a thin layer of vaseline gauze, add multiple layers of degreasing gauze and cotton pad, and bandage it with uniform pressure. For burns, bandaging therapy and exposure therapy can also be used. Burns are often complicated with infection, so antibiotics should be added and tetanus antitoxin can be injected.