What Are the Best Methods for Reducing Scar Tissue?

Scar tissue refers to fibrous connective tissue formed by granulation tissue after reconstruction and maturation. At this time, the tissue consists of a large number of parallel or staggered bundles of fibrous connective tissue. Fiber bundles tend to be homogeneous red stains, vitreous.

Scar repair

Right!

Fibrocytes are rare, the nucleus is slender and deeply stained, and blood vessels in the tissue are reduced. It is generally in a contracted state, pale or grayish translucent, hard and tough, and lacks elasticity.

1. Caused by superficial ° burn or superficial infection. Except the table is slightly different from normal skin, the surface is rough

The perfect removal

Scar repair surgery for scars

1. Surgical treatment of scars ^[2]

1) Tags: surgery, primary surgery

2) Technical principle

For severe depressions, atrophic scars, and hypertrophic scars, surgical resection is the main method. However, the scar cannot be completely removed by any surgical method. It only improves or corrects the damage caused by the scar to the greatest extent. New scars should form.

3) Adaptation and contraindications

Adapt to the crowd

Flat scars, hypertrophic scars, depression scars, and atrophic scars that affect appearance, paresthesia, or affect site function.

Contraindications

a. People with scar constitution;

b. Inflammatory skin diseases such as chronic radiation dermatitis, purulent dermatitis, recurrent herpes simplex, acne with obvious inflammation, pigmented dry skin disease, etc .;

c. Blood disease or abnormal coagulation mechanism;

d. People with mental illness or people with various mental disorders;

e. People with severe diabetes or heart and lung disease and severe hypertension.

4) Technical methods

After local disinfection, make an incision along the border of the scar, and infiltrate the scar with anesthesia.

Cut the skin and subcutaneous tissue according to the designed incision to remove the scar tissue; when the area of the scar is too large or the tension is large, you can use the method of fractional resection, every 3 months between surgical operations, and gradually remove the scar; serious Patients need to be repaired with free flaps from other parts.

Thoroughly stop bleeding, suture reduction and subcutaneous suture first, and then suture the skin with silk suture.

5) risks and complications

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

Local hematoma: Scar removal surgery will cause facial skin and soft tissue damage, and bleeding and hematoma may occur.

Scar hyperplasia: The surgical incision may show a linear depression or scar hyperplasia. Once abnormal scars are found, it is advisable to go to a regular hospital for local repair after the scar is stable 3-6 months after surgery.

Wound cracking: It is mostly caused by excessive scar removal, too much suture tension, or wound cracking caused by the patient's violent activities.

6) Postoperative recovery time

Due to different body constitutions, the time required for wound healing is also different, so the time to remove the stitches after surgery

It is not the same, it is usually 5-14 days to remove the wire, and it will basically recover within 1-4 weeks after the wire is removed.

7) Precautions

Precautions

a. Do not put on makeup before acne scar repair surgery;

b. Within two weeks before acne scar repair surgery, please do not take medicines containing aspirin, so as not to reduce the platelet coagulation function of the body;

c. Patients with hypertension and diabetes must inform the doctor of the condition before surgery;

d. Women should avoid menstrual periods when performing scar repair.

Postoperative precautions

a. Make sure that the surgical site is clean after the scar repair operation;

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

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

d. Patients should take medication and follow up strictly following the doctor's advice after scar repair.

2. Skin grinding for scars

1) Label: Surgery, primary to tertiary surgery

2) Technical principle

Dermabrasion is a method for treating skin diseases by using mechanical abrasion. When treating scars, the grinding head of the grinder rotates at high speed to controllably and mechanically grind the epidermis and superficial layer of the scar. Repair the basal cells in the epidermis and the spinal cells near the basal layer, as well as the remaining skin appendages such as hair follicle walls, small sweat gland duct walls, and sebaceous duct duct walls. When the wound is healed, the tissue on the skin surface can change and The collagen fibers and elastic fibers of the dermis are rearranged, and the remaining skin appendages (hair follicles, sebaceous glands, sweat glands) will quickly form new epidermis, thereby completing the treatment of scars.

3) Adaptation and contraindications

Adapt to the crowd: superficial depression scars, hypertrophic scars and flat scars with uneven surface.

Contraindications

a. Hemophilia or bleeding disorders;

b. Active patients with infectious hepatitis;

c. emotional instability, demanding too much;

d. Patients with medical diseases such as diabetes, refractory hypertension, cardiovascular and cerebrovascular diseases or pulmonary diseases;

e. People with abnormal pigmentation and chloasma before treatment;

f. Keloid constitution, large and deep scars, hypertrophic scars;

g. Patients with skin diseases such as active psoriasis, vitiligo, severe eczema;

h. Patients with suspected malignant skin lesions or diagnosed with skin malignancies;

i. Those who have obvious skin infections;

j. Those with a history of radiation therapy or radiation dermatitis within 6 months.

4) Technical methods

After successful anesthesia, the local surgical field was routinely disinfected. A conical grinding head is installed on the drill joint of the grinding machine, and the grinding head is driven to rotate at a high speed. The grinding head and the skin contact the skin surface in parallel and rub the skin surface. During the operation, the skin debris and blood were washed with saline, and the wound was compressed with saline gauze for 5-10 minutes to observe whether the wound was bleeding. After the operation, Vaseline oil gauze was applied externally, and 6-8 layers of sterile gauze was used for pressure bandaging.

5) Postoperative adverse reactions

Pigmentation: The most common complication after grinding is pigmentation. The wound is initially reddish, and then gradually becomes light brown or dark brown. It reaches a peak at 4-5 weeks, and then gradually fades. 3-6 months, or even years.

Skin redness: This is the first complication after grinding. The length of time varies from person to person and usually disappears within 1-3 months.

Pain: Most patients have no pain or only slight pain after surgery.

Edema: Mild edema sometimes occurs after grinding, and usually disappears by itself within 3-6 weeks.

Chestnut papular rash: It usually occurs 2-6 weeks after surgery. It is caused by damage and obstruction of gland ducts caused by grinding. Generally, it does not need to be treated by itself and can be resolved on its own.

6) Treatment course and recovery time

Deeper scars often require a second operation to obtain a satisfactory result. The two surgeries were more than two months apart. The exudation time of the wound exudate is 2-4 days after operation. The patient's wound is dry and itchy on the surface after 3-4 days. Be careful not to scratch. The outer dressing can be removed 7 days after the operation, and the natural healing time of the wound is 10-14 days.

7) Precautions

Ensure that the surgical site is clean to prevent infection and can be used when blood clots or secretions are found on the wound

Wipe with sterile saline.

Try to avoid getting water on the operation site within 7 days after the operation.

To prevent pigmentation on the face, a large dose of vitamin C can be taken after surgery, 1.5-2.0 daily

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

Strictly follow the doctor's advice to take medicine and follow up.

Avoid eating irritating foods such as peppers during the postoperative recovery period.

3. Skin and soft tissue expansion for scar treatment

1) Tags: surgery, primary surgery

2) Technical principle

Skin tissue expansion is a surgical method that uses the expansion of tissue expanders to obtain additional skin and soft tissues for skin defect repair and organ reconstruction. Its advantages are that it can provide skin and soft tissues that exactly match the recipient area and expand the donor area after the flap is transferred. There are no sequelae deformities and severe scars, and the treatment effect is good; the disadvantage is that it requires secondary surgery and the treatment cycle is long.

3) Adaptation and contraindications

Adapt to the crowd

a. Patients with scars in various parts of the body, especially those with scarred baldness and surface organ reconstruction;

b. All parts of the body surface need to be repaired or reconstructed, the local flap donor area is insufficient, and there is normal skin available for expansion around.

Contraindications

a. Those with a recent history of radiation therapy in the area to be expanded;

b. Poor blood coagulation or bleeding tendency;

c. severe malnutrition;

d. Patients with systemic infection or acute infection at the surgical site;

e. People with mental disorders who cannot cooperate.

4) Technical methods

Perform a routine check before surgery, choose the size and shape of the dilator according to the site and area of the scar to be removed, and combine with normal skin conditions;

Design an incision in the scar along the edge of the scar, implant the dilator into the deep layer of the skin according to the site, and place the injection device outside the body to suture the wound in layers after sufficient hemostasis;

Regularly inject water into the embedded dilator to expand the dilator and expand the skin and soft tissue on the surface of the dilator;

When the area of the skin to be expanded reaches a certain level, generally three times the area of the scar, perform a two-stage operation, remove the dilator, remove the scar, and use the expanded skin flap to repair the defect by advancing and rotating the defect area. Layering Suture the wound and place a drainage strip under the flap.

5) risks and complications

Exposure of the dilator: The dilator exposed or leaked from the dilation capsule cannot be used to expand the skin;

Infection: Pathogens invade from the injection device and spread to the surroundings through the catheter, causing infection at the site of the dilator;

Postoperative hemorrhage or hematoma: if the hemostasis is insufficient or the postoperative drainage is not smooth when the dilator is implanted, it is easy to cause hematoma and infection;

Disorder of blood circulation of the flap: blood circulation disturbance of dilated flap may occur in the middle and late stage of injection;

6) Treatment course and recovery time

Water injection expansion usually takes 2-6 months, usually 1-2 times a week, the amount of water injection each time until the patient feels pain; the second stage surgery to repair the defect site about 7-10 days to remove the suture.

7) Precautions

After implanting the dilator, prevent the dilator from rupturing and leaking due to the impact and compression of the dilator;

Avoid mosquito bites on the skin flaps at the expansion site, and prevent the skin infections from rupturing;

If the skin of the implanted dilator is red, swollen, hot or painful, or if there is secretion outflow and temperature rise, you should go to the hospital for treatment;

Pay attention to personal hygiene, keep the skin clean and dry, and clothes should be soft and comfortable to prevent infection of the expanded flaps to improve the success rate of surgery.

Eat a high-protein, high-vitamin diet, increase the body's resistance, and avoid spicy foods such as spicy food.

Scar repair physical therapy scar

Laser treatment of scar

1) Label: Non-surgical

2) Technical principle

After laser irradiation, it will produce photothermal effect, photochemical effect, pressure effect, electromagnetic field effect and biological stimulus effect on the skin tissue, so that the damaged dead tissue in the skin scar is quickly pyrolyzed, gasified, or broken into tiny fragments, which will be broken into the body. Phagocytic cells are excreted after phagocytosis, thereby achieving the purpose of calming scars.

3) Adaptation and contraindications

Adapt to the crowd: patients with mild scars.

Contraindications

a. People with scar constitution;

b. Impaired coagulation mechanism, low immune function, chronic wasting disease, systemic or local infection

Lesions;

c. People with photosensitivity;

d. People with various mental and psychological disorders and endocrine disorders should be used with caution;

e. Lupus erythematosus, vitiligo, and application of hormones, salicin, and light-sensitive drugs within 1 month

Use with caution.

4) Technical methods

Before treatment, clean the face, mark the scope of scar repair, do local infiltration anesthesia, turn on the power to preheat the laser, test the appropriate parameters before testing 1-2 spots in the lesion to observe the reaction. After no adverse reactions, treat the acne scar. The area was treated with laser, and after the treatment, it was wrapped with sterile gauze.

5) risks and complications

Pigmentation: The mechanism of pigmentation is not completely clear at present. Most people believe that this phenomenon belongs to the subsequent secondary pigmentation of inflammation, which is related to factors such as excessive sunlight exposure after treatment and deep skin tone.

Superficial scars: may be caused by excessive treatment dose or repeated irradiation in the treatment area, excessive cooling head temperature, insufficient skin cooling, and improper self-care after surgery. When scars are found, they should be treated in time.

Infection: After treatment, erythema exudate may occur if the wound surface is broken due to scratching or water pollution. Once infection occurs, seek medical treatment as soon as possible to promote the healing of the wound as soon as possible, but superficial scars may remain after healing.

Itching: Rarely, it may mean wound healing, but also be alert to the possibility of infection.

6) Treatment course and recovery time

The speed of laser treatment for scars depends on the area of the skin to be treated. Generally speaking, the duration of each treatment is not longer than 20 minutes, but it may be necessary to treat twice a week for a total of more than 8 times. After treatment, the skin color will become closer and closer to normal skin color, and some will be darker than normal skin color. After several months of recovery, it will be similar to the original skin color.

7) Precautions

Keep the wound clean and dry after surgery to avoid contamination of the wound with water or cosmetics. Avoid strenuous exercise,

In case the wound is pulled apart.

The wound is naturally exfoliated. Do not forcibly remove the epidermis to prevent hypertrophy of scars.

Avoid sun exposure after the peeling of the scalp skin. Photosensitivity drugs and foods are prohibited, and sunscreen can be applied to prevent pigmentation.

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

2. Cryotherapy for scars

1) Label: Non-surgical

2) Technical principle

Cryotherapy to treat scars is to use low temperature to act on the diseased tissue to cause necrosis, so as to achieve the purpose of treatment. Its mechanism of action is the formation of ice crystals inside and outside the tissue, dehydrating and shrinking the cells, and denaturing the lipoprotein complex of the cell membrane, thereby playing a role in repairing scars and smoothing the skin surface.

3) Adaptation and contraindications

Adapt to the crowd: patients with small hypertrophic scars and other small areas.

Contraindications

a. history of temperature allergy, limb paralysis, skin sensation or local circulation dysfunction, poor blood supply;

b. Menstrual period, pregnancy period;

c. Other systemic diseases, such as hypertension, cardiovascular disease, coagulopathy, diabetes, and immunocompromised conditions such as radiotherapy and long-term hormone therapy;

d. Those with scar constitution;

e. People with mental disorders;

f. Severe cold urticaria, cold globulinemia, and cold fibrinemia.

4) Technical methods

The cryotherapy machine is turned on. After the treatment head cools down, it is gently pressed on the surface of the facial scar. The frozen contact time is 5 seconds to 3 minutes, and 2 freeze-thaw periods. After the treatment, in order to avoid infection and inflammation, apply anti-inflammatory cream daily.

5) risks and complications

Pain: There is local pain within 1-2 days after cryotherapy, especially within 1-2 hours. If the pain is obvious, you can take painkillers as prescribed by your doctor.

Edema: After thawing, the local edema begins to appear and reaches a peak within 24 hours. The edema begins to subside within 3-4 days. Those with obvious edema can use topical glucocorticoid cream according to the doctor's advice.

blisters: those with a longer freezing period may have blisters or bullae locally in 2-3 hours after surgery. In severe cases, go to the hospital for treatment in time.

Infection: Rarely, it is often caused by blister rupture after operation, and secondary infection is not paid attention to hygiene.

Pigmented spots: After the inflammation formed by freezing has subsided, some patients may have secondary pigmented spots, which usually subside after a few months.

6) Treatment course and recovery time

The course of treatment for each scar site is two to three cycles of "freeze-thaw" with a duration of about 30 seconds. More severe scars require more than two courses, and the interval between each course should be 25 days.

7) Precautions

Wounds should be kept clean and dry after operation, and should not be exposed to water to prevent secondary infections;

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

Try to avoid the sun after the scabs fall off to prevent skin pigmentation.

3. Radiation Therapy for Scars

1) Label: Non-surgical

2) Technical principle

When the scar area is treated with radiation, both shallow X-rays and -rays can greatly reduce the number of fibroblasts in the scar tissue and impair the function. The synthesis of collagen fibers and matrix is reduced, and the decomposition of collagen fibers is increased. Makes the scar area flat and soft.

3) Adaptation and contraindications

Adapt to the crowd: patients with hypertrophic scars who are unwilling or unsuitable for surgery;

Contraindications

a. Scar patients with severe insufficiency of important organs such as heart, lung, kidney;

b. Combining various infectious diseases such as active hepatitis and active tuberculosis patients;

c. Those with scars or ulcers.

4) Technical methods

According to the scar site, the area and dose of each irradiation is about 100-150R, once every 1-2 weeks.

5) risks and complications

Burns may occur at the irradiation site, which may also be accompanied by capillary dilatation;

Skin erythema, itching, skin paresthesia, burning sensation and other symptoms will appear shortly after irradiation, and a small number of scar patients will have secondary hyperkeratosis;

Adverse reactions such as pigmentation and skin atrophy may occur.

6) Treatment course and recovery time

Patients with scars are irradiated once every 1-2 weeks, and a continuous course is 4-6 times. Depending on the severity of the scar, patients can be irradiated repeatedly at intervals of 1-2 months.

7) Precautions

Protect the skin of the irradiation site. It is required to be clean and dry. Do not rub or use irritating drugs. Do not apply heat and physical therapy. Avoid wind and sun.

Radiation skin reaction, such as colic liver oil ointment, cortisone cold cream or antipruritic agent can be used to relieve itching when itching skin; if wet dermatitis occurs, it should be administered under the guidance of a doctor.

The diet should be high in nutrition, easy to digest, and avoid irritating food.