1) label: operation, first-class operation.

2) technical principle

Surgical resection is the main method to treat severe concave scar, atrophic scar and hypertrophic scar, but any surgical method can not completely remove the scar, and can only improve or correct the harm caused by the scar to the greatest extent, so it is appropriate to form a new scar after operation.

3) Adapt to the crowd and taboo crowd

① Adapt to the crowd

Flat scar, hyperplastic scar, concave scar and atrophic scar that affect the appearance and abnormal sensation or affect the function of this part.

② Taboo crowd

A. people with scar constitution;

B inflammatory dermatoses such as chronic radiation dermatitis, suppurative dermatoses, recurrent herpes simplex, acne with obvious inflammation, xeroderma pigmentosum, etc.

C. Blood diseases or abnormal coagulation mechanism;

D. mental patients or people with various psychological obstacles;

E. People with severe diabetes or heart and lung diseases and severe hypertension.

4) Technical methods

① After local disinfection and towel laying, incision design was made along the scar boundary, and the scar area was infiltrated with anesthetic.

② Cut the skin and subcutaneous tissue according to the designed incision to remove the scar tissue; When the scar area is too large or the tension is high, the scar can be removed step by step, and the interval between the two operations is 3 months. Severe cases need to be repaired with free skin flaps from other parts.

③ To stop bleeding completely, suture under the skin to reduce tension, and then suture the skin intermittently with silk thread.

5) Risks and complications

① Infection: Complications such as infection and poor wound healing may occur at the surgical site after scar resection.

② Local hematoma: Scar excision will cause facial skin and soft tissue injury, and bleeding and hematoma may occur.

③ Scar hyperplasia: The surgical incision may be linear and uneven or scar hyperplasia. Once abnormal scars are found, it is recommended to go to a regular hospital for local trimming after 3-6 months of operation.

④ Wound dehiscence: Most of them are caused by excessive scar excision, excessive suture tension, or severe activity of patients.

6) Postoperative recovery time

Due to different constitutions, the time required for wound healing is also different, so the time for suture removal after operation is also different.

It's not the same. Generally, stitches were removed in 5- 14 days, and basically recovered in 1-4 weeks after stitches were removed.

7) Precautions

① Precautions before operation

A. Do not make up before acne scar repair surgery;

B. Do not take drugs containing aspirin within two weeks before acne scar repair surgery, so as not to reduce the platelet coagulation function of the body;

C. Patients with hypertension and diabetes should inform the doctor in detail before operation;

D. Women should avoid menstrual period when performing scar repair surgery.

② Precautions after operation

A. Ensure the surgical site is clean after scar repair;

B. Try to avoid water on the surgical site within 7 days after scar repair;

C. Avoid eating irritating foods such as peppers after scar repair;

D after scar repair, patients should take medicine in strict accordance with the doctor's advice and make follow-up visits.

2. Skin grinding is used for scar treatment.

1) tab: operation, level 1 to level 3 operation.

2) technical principle

Skin grinding is a method to treat skin diseases by mechanical friction. When treating scars, the grinding head of the grinding machine rotates at high speed, and the superficial layers of epidermis and dermis can be controlled by mechanical grinding, so as to repair basal layer cells in epidermis and spinous cells near basal layer, as well as residual skin appendages such as hair follicle wall, eccrine gland tube wall and sebaceous gland tube wall. When the wound heals, the tissue on the skin surface can change, and the collagen fibers and elastic fibers in the dermis can be restored.

3) Adapt to the crowd and taboo crowd

① Suitable crowd: superficial concave scar, hypertrophic scar and flat scar with uneven surface.

② Taboo crowd

A. hemophilia or abnormal bleeding;

B. Patients with active infectious hepatitis;

C. emotional instability and excessive demands;

D. People with diabetes, intractable hypertension, cardiovascular and cerebrovascular diseases or lung diseases;

E. those with abnormal pigment and chloasma before treatment;

Keloid constitution, large and deep scars and hypertrophic scars;

G patients with active psoriasis, vitiligo and severe eczema;

H patients whose skin lesions are suspected to be malignant or have been diagnosed as skin malignant tumors;

First, the local skin is obviously infected;

J. Have a history of radiotherapy within six months, or have radiation dermatitis.

4) Technical methods

After the successful anesthesia operation, the local operation field was routinely disinfected and covered with a towel. The conical grinding head is installed on the drill pipe joint of the grinder to drive the grinding head to rotate at high speed. The grinding head contacts the leather surface parallel to the skin and rubs the leather surface. During the operation, the skin debris and blood of the wound were washed with normal saline, and the wound was compressed with normal saline gauze for 5- 10 minutes to observe whether the wound was bleeding. After operation, vaseline gauze was applied externally, disinfected for 6-8 layers, and wrapped with thick gauze under pressure.

5) Adverse reaction after operation

① Pigmentation: Pigmentation is the most common complication after grinding. The wound was red at first, and then gradually turned to light brown or dark brown, reaching a peak in 4-5 weeks, and then gradually subsided for 3-6 months or even years.

(2) Redness of skin: This is the first complication after grinding. Its existence period varies from person to person, and generally disappears within 1-3 months.

③ Pain: Most patients have no pain or only slight pain after operation, so they can use analgesics according to the doctor's advice.

④ Edema: Sometimes slight edema appears after grinding, and generally disappears after 3-6 weeks.

⑤ Chestnut papule: It often occurs 2-6 weeks after operation, which is caused by the injury and obstruction of glandular duct caused by grinding. Generally, you don't need self-treatment, you can disappear on your own.

6) Course of treatment and recovery time

Deep scars often require secondary surgery to obtain satisfactory results. The interval between the two operations is more than two months. The postoperative wound exudation time is 2-4 days, and the patient's wound is dry and itchy 3-4 days after operation, so be careful not to scratch at this time. The external dressing can be removed 7 days after operation, and the natural healing time of the wound is 10- 14 days.

7) Precautions

(1) Ensure that the surgical site is clean and prevent infection. If there is blood scab or secretion on the wound, it can be used.

Sterile saline wiping.

(2) Try to avoid water on the surgical site within 7 days after operation.

③ To prevent facial pigmentation, high-dose vitamin C can be taken after operation, 1.5-2.0 per day.

G, at the same time external use hydroquinone cream, avoid the sun, can use sunscreen when going out.

(4) Strictly follow the doctor's advice and make follow-up visits.

⑤ Avoid eating irritating food, such as pepper, in the recovery period after operation.

3. Skin and soft tissue expansion is used for scar treatment.

1) label: operation, first-class operation.

2) technical principle

Skin tissue expansion is a surgical method for skin defect repair and organ reconstruction by using the expansion of tissue expander to obtain additional skin and soft tissue. Its advantages are that it can provide skin and soft tissue completely matched with the recipient, and there is no residual deformity and serious scar in the donor site after the expanded flap transfer, and the treatment effect is good. The disadvantage is that a second operation is needed and the course of treatment is long.

3) Adapt to the crowd and taboo crowd

① Adapt to the crowd

A. Patients with scars in all parts of the body, especially those with cicatricial baldness and body surface organ reconstruction;

B all parts of the body surface need to be repaired or reconstructed, but the donor site of local skin flap is insufficient, and there is normal skin around it for expansion.

② Taboo crowd

Recent radiotherapy history of the area to be expanded;

B. those with poor coagulation function or bleeding tendency;

C. people with severe malnutrition;

D. Patients with systemic infection or acute infection at the operation site;

E. mentally retarded and uncooperative people.

4) Technical methods

① Routine preoperative examination, selecting the size and shape of dilator according to the position, area and normal skin condition of scar to be removed;

② Incision was designed along the edge of scar, expander was implanted into the deep skin according to different parts, the injection device was placed outside the body, and the wound was sutured in layers after full hemostasis;

③ Inject water into the implantable dilator regularly to expand the dilator and expand the skin and soft tissue on the surface of the dilator;

(4) When the expanded skin area reaches a certain level, which is generally 3 times of the scar area, the second-stage operation is performed, the expander is taken out to remove the scar, the expanded flap is used to repair the defect by pushing the defect area, the wound is stitched in layers, and a drainage strip is placed under the flap.

5) Risks and complications

① Exposed dilator: the dilator implanted in the body is exposed or the expansion sac leaks, which can not expand the skin;

② Infection: Pathogenic bacteria invaded from the injection device and spread around through the catheter, causing infection at the dilator implantation site;

③ Hemorrhage or hematoma after operation: If the bleeding is not enough when the dilator is implanted or the drainage is not smooth after operation, it is easy to cause hematoma and infection;

④ Blood circulation disorder of skin flap: Blood circulation disorder of expanded skin flap may occur in the middle and late period of injection;

6) Course of treatment and recovery time

Water injection usually takes 2-6 months, usually twice a week 1-2 times, and the amount of water injection each time is subject to the pain felt by the patient; The suture was removed about 7- 10 days after the second operation to repair the defect.

7) Precautions

① After the dilator is implanted, prevent the dilator from breaking and leaking due to the impact and extrusion of external force on the dilator;

(2) Prevent the expanded skin flap from being bitten by mosquitoes, and prevent the skin flap from infection and rupture;

(3) If the skin where the dilator is implanted appears redness, swelling, heat pain, secretion outflow and temperature rise, you should go to the hospital in time;

④ Pay attention to personal hygiene, keep skin clean and dry, keep clothes soft and comfortable, prevent expanded flap infection and improve the success rate of operation.

5 Eat a high-protein and high-vitamin diet, increase the body's resistance, and avoid irritating foods such as spicy food. 1. Laser treatment of scars

1) Label: Non-surgical.

2) technical principle

After laser irradiation, it will produce photothermal effect, photochemical effect, pressure effect, electromagnetic field effect and biological stimulation effect on skin tissue, so that the damaged and necrotic tissue at the skin scar can be quickly pyrolyzed, gasified or broken into tiny fragments, which will be swallowed up by phagocytes in the body and discharged from the body, thus achieving the purpose of calming the scar.

3) Adapt to the crowd and taboo crowd

① Adaptive population: patients with mild scar.

② Taboo crowd

A. people with scar constitution;

B. Obstruction of coagulation mechanism, hypoimmunity, chronic wasting disease, systemic or local infection.

Lesions;

C. people who are allergic to light;

D. Use with caution for people with various mental and psychological abnormalities and endocrine dysfunction;

E. Use hormones, salicin and photosensitive drugs in the progressive stage of lupus erythematosus and vitiligo and within 1 month.

Use with caution.

4) Technical methods

Before treatment, clean the face, mark the scar repair range, do local infiltration anesthesia, turn on the power supply to preheat the laser, and test 1-2 points at the focus to observe the reaction. After no adverse reaction, laser treatment was performed at the acne scar, and after treatment, it was wrapped with sterile gauze.

5) Risks and complications

① Pigmentation: At present, the mechanism of pigmentation is not completely clear. Most people think that this phenomenon belongs to secondary pigmentation after inflammation, which is related to factors such as excessive sunlight exposure and darkening of skin after treatment.

② Superficial scar: It may be caused by excessive treatment dose or repeated irradiation in the treatment area, too high temperature of the cooling head, insufficient skin cooling, improper postoperative self-care, etc. When scars are found, they need timely treatment.

③ Infection: After treatment, if the wound is scratched or polluted by water, erythema may appear. In case of infection, seek medical attention as soon as possible to promote wound healing as soon as possible, but superficial scars may be left after healing.

4 itching: rare, which may mean the healing of the wound, but we should also be alert to the possibility of infection.

6) Course of treatment and recovery time

The speed of laser treatment of scars depends on the skin area to be treated. Generally speaking, the time of each treatment will not exceed 20 minutes, but it may need to be treated twice a week, and * * * needs more than 8 treatments. After treatment, the skin color will be closer to the normal skin color, some will be darker than the normal skin color, and will be similar to the original skin color after several months of recovery.

7) Precautions

① Keep the wound clean and dry after operation to avoid water or cosmetics polluting the wound. Avoid strenuous exercise,

To prevent the wound from tearing.

② The wound naturally scabs, and the scab skin cannot be forcibly removed to prevent scar hyperplasia.

(3) Avoid sun exposure after scabbing and peeling, prohibit photosensitive drugs and food, and apply sunscreen to prevent pigmentation.

④ Pay attention to the prevention and treatment of complications such as infection, scar, pigmentation and purpura.

2. Cryotherapy for scar.

1) Label: Non-surgical.

2) technical principle

Cryotherapy is used to treat scars by acting on diseased tissues at low temperature to make them necrotic. Its mechanism of action is to form ice crystals inside and outside the tissue, so that the cells dehydrate and contract, and the lipoprotein-like complex of the cell membrane denatures, thus playing a role in repairing scars and calming the skin surface.

3) Adapt to the crowd and taboo crowd

① Suitable crowd: patients with small hypertrophic scars and other small scars.

② Taboo crowd

History of temperature allergy, limb paralysis, skin sensory or local circulation dysfunction, poor blood supply, etc.

B. menstrual period and pregnancy;

C other systemic diseases, such as hypertension, cardiovascular diseases, coagulation diseases and diabetes, and patients with low immune function, such as radiotherapy and long-term hormone therapy;

D. people with scar constitution;

E. patients with mental disorders;

F. Severe cold urticaria, cryoglobulinemia and cryofibrinemia.

4) Technical methods

After the cryotherapy machine is turned on, gently press it on the facial scar surface after the treatment head cools down. The freezing contact time is 5 seconds to 3 minutes, and there are two freezing and thawing periods. After the treatment, you can apply anti-inflammatory ointment every day to avoid infection and inflammation.

5) Risks and complications

① Pain: There is local pain within 1-2 days after cryotherapy, especially within 1-2 hours. Those with obvious pain can take painkillers according to the doctor's advice.

② Edema: After thawing, local edema began to appear, reaching its peak in 24 hours, and began to subside in 3-4 days. If edema is obvious, glucocorticoid cream can be used for external use according to the doctor's advice.

③ Blister: For those who have been frozen for a long time, blisters or bullae may appear locally 2-3 hours after operation, and those who are serious should go to the hospital for treatment in time.

④ Infection: It is rare, and it is often secondary to infection due to the rupture of blisters caused by carelessness after operation.

⑤ Pigmented spots: After the inflammation caused by freezing subsides, some patients may have secondary pigmented spots, which usually subside spontaneously after several months.

6) Course of treatment and recovery time

The treatment process of each scar site is two or three "freeze-thaw" cycles, and the time is about 30 seconds. Severe scars require more than two courses of treatment, and each course of treatment is 25 days apart.

7) Precautions

① Keep the wound clean and dry after operation to prevent secondary infection;

② Don't tear it forcibly after scabbing, and let it fall off naturally;

(3) Try to avoid the sun after the scab falls off to prevent skin pigmentation.

3. Radiotherapy of scar

1) Label: Non-surgical.

2) technical principle

When radiotherapy is used to treat scars, both superficial X-rays and β-rays can greatly reduce the number of fibroblasts in scar tissue, damage their functions, reduce the synthesis of collagen fibers and matrix, and increase the decomposition of collagen fibers, thus making scars flat and soft.

3) Adapt to the crowd and taboo crowd

① Suitable for people: patients with hypertrophic scars who are unwilling or unsuitable for surgery;

② Taboo crowd

A. Scar patients with severe dysfunction of important organs such as heart, lung and kidney;

B. Patients with various infectious diseases such as active hepatitis and active tuberculosis;

C. the scar is damaged or festered.

4) Technical methods

According to the scar site, the irradiation area and amount are about 100- 150R, once every 1-2 weeks.

5) Risks and complications

(1) burns and telangiectasia may occur at the irradiated site;

② Symptoms such as skin erythema, itching, abnormal skin sensation and burning sensation will appear in a short time after irradiation, and a few scar patients will have secondary epidermal hyperkeratosis;

③ Adverse reactions such as pigmentation and skin atrophy may occur.

6) Course of treatment and recovery time

Scar patients are irradiated once every 1-2 weeks, and continuous irradiation for 4-6 times is a course of treatment. According to the severity of scar, the patient can repeat irradiation every 1-2 months.

7) Precautions

(1) To protect the skin in the irradiated area, it is required to be clean and dry. Don't rub hard or use irritating drugs, don't apply heat and physical therapy, and avoid the wind and the sun.

② Radioactive skin reaction, such as skin itching, can be relieved by cod liver oil ointment, cortisone cold cream or antipruritic agent; If you have wet dermatitis, you should take it under the guidance of a doctor.

③ The diet should be nutritious, easy to digest and avoid irritating food.