Abstract
The ideal scar should be flat and level with surrounding skin without depressions, bulges, or step-offs that create shadows in certain lighting. Scars should be narrow and should not cause distortion of adjacent tissue. Ideal scars should display the same color and texture as surrounding skin. Ideal scars should be parallel to relaxed skin tension lines (RSTLs) or lie in a natural skin crease. Scar color and texture may be improved with dermabrasion or laser treatments. Scar excision is the simplest scar revision technique. It is used to reduce wound closure tension, change the shape of a scar, correct uneven tissue apposition, or fill in contour depressions. Scar irregularization may improve the appearance of scars that are long (>2 cm), straight, predictable, and that are followed easily by an observer’s eye. Irregularization may take the form of Z-plasty, W-plasty or geometric broken line (GBL) scar revision. Z-plasty can be used to interrupt scar linearity, elongate contracted scars, efface webs or clefts, and change the orientation of scars so that the majority of the length of a scar is aligned with RSTLs. W-plasty creates a scar that avoids sharp demarcation between scar and adjacent skin by interdigiting small triangles of normal unscarred skin, which has the effect of camouflaging the scar. It is indicated for scars of the forehead, eyebrow, temple, nose, cheek, and chin that are oriented 35° or more from RSTLs. The greatest disadvantage of W-plasty scar revision is that the procedure creates a predictably irregular scar. Thus long W-plasties may cause a scar to be more detectable than if a GBL scar revision is performed. The randomness of GBL design causes the scar to be more difficult for the observer’s eye to follow, thus having the effect of scar camouflage. GBL is most useful for treating scars that are long and linear that cross RSTLs.
Published Version
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