Hypertrophic scars
Hypertrophic scars are often confused with keloid
scars, since both tend to be thick,
red, and raised. Hypertrophic scars, however, remain within the boundaries of
the original incision or wound. They often improve on their own-though it may
take a year or more-or with the help of steroid applications or injections.
This hypertrophic scar has formed a
contracture, restricting finger motion.
If a conservative approach doesn't appear to be effective, hypertrophic scars
can often be improved surgically. The plastic surgeon will remove excess scar
tissue, and may reposition the incision so that it heals in a less visible
pattern. This surgery may be done under local or general anesthesia, depending
on the scar's location and what you and your surgeon decide. You may receive
steroid injections during surgery and at intervals for up to two years afterward
to prevent the thick scar from reforming.
Using Z-plasty, the scar is removed and
several incisions are made on each side,
creating small triangular flaps of skin.
Then the flaps are rearranged and
interlocked to cover the affected area.
The incision is closed with a Z-shaped
line of sutures. The new scar is thinner
and less visable, and allows the finger
to be extended.
Contractures
Burns or other injuries resulting in the loss of a large area of skin may form a
scar that pulls the edges of the skin together, a process called contraction.
The resulting contracture may affect the adjacent muscles and tendons,
restricting normal movement.
Correcting a contracture usually involves cutting out the scar and replacing it
with a skin graft or a flap. In some cases a procedure known as
Z-plasty may be used. And new techniques, such as tissue expansion,
are playing an increasingly important role. If the contracture has existed for
some time, you may need physical therapy after surgery to restore full function.