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Formation and Revision of the Cicatrix

Formation and Revision of the Cicatrix. Herve’ LeBoeuf, MD Karen Calhoun, MD. Tension Lines. Langer’s lines Relaxed Skin Tension Lines Unique to each patient Frequently perpendicular to muscle Different from “wrinkle lines” Identified by pinching the skin

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Formation and Revision of the Cicatrix

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  1. Formation and Revision of theCicatrix Herve’ LeBoeuf, MD Karen Calhoun, MD

  2. Tension Lines • Langer’s lines • Relaxed Skin Tension Lines Unique to each patient Frequently perpendicular to muscle Different from “wrinkle lines” Identified by pinching the skin • Straith, Kraissl, Bulacio

  3. Wound Healing • Neovascularization • Inflammation • Epithelialization • Granulation • Contraction • Remodeling

  4. Preoperative Management • Debridement & Irrigation • Instrumentation • Anesthesia • Incision planning • Patient consultation

  5. Intraoperative Precautions • Incision placement • Undermine where necessary • Meticulous hemostasis • Dead space obliteration • **Dermal closure** • Suture type & placement • Anti-tension taping of wound

  6. Postoperative wound care • Topical emollients for moisture • Frequent cleaning with H2O2 • Early dermabrasion of irregular wounds • Avoidance of sun, water • Steroid creams, retinoids, etc.

  7. Goals of scar revision • Flat scar, level with surrounding skin • Good color match with local tissue • Narrow • Parallel to the patient’s RSTL • Absence of straight, unbroken lines

  8. Scars that may benefit... • Those interrupting a facial aesthetic unit • Webbed or pin cushion scars • Hypertrophied or widened scars • Those adjacent to a favorable site • Long scars perpendicular to RSTL • Aesthetically or functionally distorting

  9. Excisional techniques • Fusiform excision with or without M-plasty Rotational flaps Tissue expanders • Repositioning of scars • Partial serial excision of larger scars

  10. Altering scar polarity • Classic Z-plasty • Multiple “running” Z-plasties • W-plasty • Geometric Broken Line Closure • Early dermabrasion with the irregular closures and hypertrophied scars

  11. Nonsurgical revisions • Steroids -- Injectables and creams • Estriol and tretinoin with iontophoresis • Silicone gel sheeting and tocopherol • Ultrapulsed CO2 laser resurfacing • Injectable fillers: Zyderm, Zyplast, Fibrel, autologous fat, Autologen, Silicone, etc. • Cosmetics

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