In modern society, because of the increase in car accidents or trauma, many people will encounter wounds on the head, face, limbs and other exposed parts. Although they can be healed after treatment, the scars left after the injury are difficult to easily erase, which also brings patients Both physical and psychological problems have been solved. With the continuous development of plastic surgery, whether it is burns, scalds, trauma, surgical trauma, and other scars, there are new possibilities for repair. However, how to repair scars also needs to be tailored, that is, according to the patient’s different physique and different scar types, a personalized “scar removal” plan is developed.
Depressed scars are scars caused by defects in the dermis and subcutaneous tissues of the skin. Acne, surgery, trauma, infection, chickenpox, etc. are common causes. These causes cause defects in the skin dermis and subcutaneous tissue. In the subsequent healing process, the lack of collagen and elastin will leave depressed scars. Common clinically depressed scars are often as small as pinholes, rice grains or soybeans, in the form of pits, sunken on the skin surface.
Mechanical skin abrasion has a good effect on depressed scars, that is, the scar is abraded by electric rotary grinding head. The advantage is that it is highly targeted, fast, and less treatment times. It is very suitable for large-area scars and pigmentation. If the selected grinding head and grinding tools are appropriate and the operator has rich experience, generally after 1 to 2 grinding operations, satisfactory results can be obtained.
In addition, laser skin rubbing can be used to smooth depressed scars. This kind of treatment actually uses a carbon dioxide laser to polish the skin. Unlike ordinary skin rubbing, laser rubbing is a relatively non-bleeding skin polishing method. At the same time, during laser treatment, it is also recommended to combine fruit acid treatment and L-C introduction. Pulsed laser has a good effect on improving the stains caused by scars, especially red spots, because pulsed light has the function of eliminating capillaries. Since the proliferation of capillaries in the skin varies in depth, from the point of view of treatment, it will be weakened once done once.
Flat scars are mostly distributed in the normal skin in the form of flakes, with a flat surface and different pigments, which are often caused by scalds, burns, cuts, etc. Can choose resection or “Z” forming surgery, the epidermis is not sutured or the incision is bonded with bio-glue during the resection, or laser abrasion can be used directly to improve the appearance and color.
If the scar continues to proliferate after the skin injury heals, it may develop into a hypertrophic scar. Hypertrophic scars are mostly protruding from the surface of the skin, with irregular shapes, unevenness, flushing and congestion, firm texture, and often accompanied by burning and itching. Symptoms when the ambient temperature is increased, emotions are increased, or when eating spicy food Intensify. Hypertrophic scars are more likely to occur in wounds whose depth of injury only reaches the dermis, such as wounds in the donor area after deep second-degree burns. They are occasionally seen in deeper wounds and surgical incisions. Such scars usually begin to subside after 6 months, and the scars of some patients become stable after two years.
Once a hypertrophic scar occurs, in addition to waiting for the scar to shrink naturally, some therapies used in the past have their own shortcomings. Such as compression therapy, although it is painless, but the effect is weak; drug injection therapy has a certain effect, but the pain is unbearable and has many side effects, and it may relapse after stopping the drug for several months; silicone gel subsidy therapy, although painless, but effective Can’t last. At present, the most ideal clinical treatment is laser skin abrasion, which is more suitable for hypertrophic scars caused by postoperative, trauma, and burns, or acne scars.
Compared with hypertrophic scars, contracture scars are often more headache. This is a kind of extensive soft tissue defect that has not been repaired, and the contracture deformity left after the scar has healed. It is common in the sequelae of third-degree burns of the limbs without early repair. In addition, diseases such as skin avulsion, extensive subcutaneous cellulite inflammation and other causes of necrosis of the skin and subcutaneous tissue of the limbs can also cause scar contracture deformities. If the contracture scar is not cured in time, it is likely to cause secondary contracture deformities in deep tissues. Due to scar contractures and lack of movement of the limbs, especially near the elbow joints, heterotopic ossification is prone to occur, further aggravating the dysfunction of the limbs, and even ankylosis. Therefore, the treatment of contracture scars should be carried out early.
Surgery is still the main method for treating contracture scars. During the operation, the initial release is usually initiated through an incision perpendicular to the longitudinal axis of the contracture, and then gradually peeled off along the hierarchical layers of the scar and normal tissues, and the wound surface is continuously enlarged until the contracture is completely resolved. Although the operation should be performed as soon as possible, it must wait until the scar is completely stable, enters the mature stage, and the base becomes loose. Premature surgery, the normal anatomical level is often not clear due to scar adhesion, accidental injury is likely to occur, and more bleeding. However, while waiting for surgery, such as contracture scars on the limbs and joints, doctors will generally guide the patient to exercise active functional activities to prevent the scar adhesion.
Keloids are scars characterized by persistent and strong proliferation, and are essentially a fibrous tissue tumor of the skin. It is clinically manifested as irregular hypertrophic neoplasms, mostly pink, protruding on the surface of the skin, growing like crab feet, often itching, pain, and acupuncture. Keloid scars are often secondary to various traumas, such as machine injuries, chemical burns, burns, etc., and often secondary to cesarean section and ear piercing. The course of keloid scars is generally long, and usually increases continuously, without the tendency to atrophy and subside spontaneously. It is most likely to appear in the front chest, jaw and neck, ears, shoulders and upper arms. It has a tendency to occur frequently in specific parts and can appear in different parts of the body at the same time. Observation under a microscope can also see the proliferation of many immature fibroblasts, the collagen fibers become clear, thick, disorderly arranged, and have a rich mucus matrix.
It should be noted that keloid scars not only affect the appearance, but may also rupture and cause cancer. Therefore, active treatment is required. However, the etiology is unknown so far. It is generally believed that the pathogenesis is caused by the crazy proliferation of fibroblasts. However, due to the unclear etiology, it also brings great difficulties to the treatment. Compression therapy, drug therapy, etc. are mostly ineffective, and it is easy to relapse after a single surgical resection, and the scar is larger than the original scar. Therefore, the comprehensive “triple therapy” based on surgery is currently advocated.
The so-called “triple therapy” is to first use the latest advanced technology to perform laser skin abrasion, using a computer to control the depth of abrasion and the smoothness of the skin (if there is a contracture, it must first be released). After the keloid is completely removed, 32P application treatment is performed, and the timing, dosage and frequency of application are scientifically grasped, and the number of fibroblasts is greatly reduced, thereby reducing the synthesis of collagen fibers, expanding the microvessels in the scar, and endothelial cells Swelling and occlusion gradually, the scar becomes flat and soft. During the inflammatory, proliferative and remodeling phases of wound healing, apply it again at regular intervals to inhibit the proliferation of fibroblasts and effectively prevent the recurrence of keloids. Nutritional rehabilitation should be strengthened after laser surgery. It is recommended to choose a high-calorie, high-protein, and high-vitamin diet, such as eggs, lean meat, milk, vegetables, and fruits, to increase resistance and promote wound healing. At the same time, avoid eating spicy and allergic foods, such as peppers and seafood.
In addition, there are too many skin care products on the cosmetics market under the banner of “scar repair” and “beauty removing scars”. Are these products effective? In this regard, the author believes that the essence contained in these cosmetics can only partially dilute the darker scars at most, but it is powerless to “smooth” raised scars, and it is impossible to fundamentally remove them. The purpose of the scar. It is recommended that for some scars with large wounds or deep tissue infiltration, patients should wait until the scars are fully mature and seek help from plastic surgeons for professional surgical repair.
Zhou steel deputy chief physician. Integrating clinical, teaching, and scientific research work, he has long been engaged in basic and clinical application research on various types of scar comprehensive treatment, and has accumulated rich clinical experience in plastic repair and reconstruction, congenital deformity repair, microsurgery, etc., especially in various types of He has deep attainments in comprehensive treatment of scars.