Generally, contracture scar surgery should make an incision along the dermatoglyphics. When the skin is defective and the suture tension is high, Z plasty should be used to repair the wound. The surgical treatment of contracture scar includes the following steps: pay attention to the timing of operation, completely relieve contracture, properly repair the wound surface and properly handle it after operation.
Generally speaking, the operation time should not be too early, and should be carried out after the scar is stable and has entered a mature stage and the basement is loose. Premature operation often leads to unclear normal anatomical level due to scar adhesion, which is prone to accidental injury and more bleeding. However, if it is around the eyelids or mouth, in order to protect vision or solve the difficulty of eating, it is necessary to operate as soon as possible. In the repair and treatment of late burn, early operation is advocated for scar contracture of functional parts to avoid secondary deformity, especially in childhood. While waiting for the opportunity of operation, if it is contracture scar of limbs, the wounded should be instructed to actively carry out functional exercise, supplemented by massage, physical therapy and physical therapy. , so as to prevent the progress of contracture, promote the softening and loosening of scars and prevent joint stiffness.
Complete release of contracture is the key step of surgical treatment. Limbs should be performed under inflatable tourniquet, which can reduce bleeding, make the operation field clear and speed up the operation progress. After the incision perpendicular to the longitudinal axis of contracture was released, the scar and normal tissue were gradually peeled off. In this process, the assistant supports the contracture to keep it tense for surgery, and the wound keeps expanding until the contracture is completely relieved. He asked that in the limbs, sometimes auxiliary operations such as tendon lengthening, joint capsule incision and joint ligament resection are needed to achieve complete release. It is convenient to apply appropriate external force when loosening, but it is forbidden to use violent traction to force joint reduction to avoid tearing nerves, blood vessels and other soft tissues. If it is really impossible to reduce, postoperative traction or joint formation or fusion can be carried out according to the situation. If it is unstable after reduction, the facet joint can be put into Kirschner wire for short-term braking for 2~3 weeks. Larger joints must be fixed with plaster bandage after operation. The principle of scar excision should be total excision, but if the area is too large or the donor site is limited, most scars can be removed on the premise of fully relieving contracture. The edge of the wound on both sides of the joint, if not in the lateral midline, must be cut into sawtooth shape.
Non-surgical treatment
Skin friction method
Apply coolant to the affected area to numb the skin and fix its surface, and then polish it with a rotatable stainless steel wheel set inlaid with fine industrial diamond. The edge of the scar can be polished, and the bottom can also be polished to enlarge the central part and flatten the surface of the repaired skin.
Chemical stripping method
Mild or superficial peeling-only superficial skin cells are gently removed-treated with trichloroacetic acid or α -hydroxy acid. For severe acne, doctors use phenol peeling, which usually requires general anesthesia by cosmetic surgeons. For common scars, doctors can peel them off with trichloroacetic acid.
New quadruple therapy
The key to the treatment of contracture scar is to relieve contracture. Contraction scar can be treated by new quadruple therapy and non-surgical comprehensive therapy. Drug is introduced by pulse wave to release scar fibrous connective tissue, thus softening and flattening the tissue. External use of scar-removing drugs promotes scar regression and promotes epidermal regeneration; Oral anti-scar Chinese patent medicine, conditioning physique.