Obtaining a fine-line scar
Closure of skin wounds
- minimal scaring: precise approximation of the skin edges, without tension
- deeper than skin: closed in layers to eliminate dead space and provide strength to prevent dehiscence, make skin edges suture no tension
- Suturing techniques
- Simple interrupted suture
- gold standard
- most common
- triangular appearance when viewed in cross section
- everting the skin edges
- 5-7 mm apart, 1-2 mm from the skin edge
- Vertical mattress suture
- eversion of the skin edge cannot be made with simple suture
- tend to leave the most obvious and unsightly cross-hatching if not removed early
- Horizontal mattress suture
- for feet and hand
- superior to vertical mattress
- Subcuticular suture
- running or interrupted
- no need to make skin suture
- absorbable or nonabsorbable suture can be used,
- removal 1-2 weeks after suturing
- Half-burried horizontal mattress suture
- suture mark is left on one side
- best for areola suture to leave the suture marks areola
- Continuous over-and-over suture
- time saving
- not as precise as interrupted sutures for skin approximation
- best for scalp suture
- Skin taples
- time saving
- temporarily to position a skin closure or flap before suturing
- grasping the wound edges with forceps to evert the tissue when placing the staples to prevent invertion
- removal early to prevent skin marks
- ideal for scalp
- Skin tapes
- buried sutures first to approximate deeper layers, relieve tension and prevent inversion
- after removal of sutures to provide additional strength
- Skin adhesives
- in areas with no tension on the skin
- buried sutures first
- do not evert the wound edges, eversion must be provided by deeper sutures
- Methods of excision
- Elliptical excision
- Wedge excision
- Circular excision
- Serial excision
- Skin graft types
- Requirement for survival of a skin graft
- Skin graft adherence
- Meshed versus sheet skin grafts
- Skin graft donor sites
- Postoperative care of skin grafts and donor sites
Skin flaps
- Flaps rotating about a pivot points
- Advancement flaps
Z-plasty
- Geometric principle of the Z-plasty
- revision, redirection and lengthening of pre-existed scar
- the limbs of the Z must be equal in length to the central limb
- classical Z-plasty
- 60 degrees
- 75% gain in length of the central limb
- actual gain in length in the direction of the central limb
- based on the mechanical properties of the skin and is always less
- Planning and uses of the Z-plasty
- postoperative central limb direction is perpendicular to the original limb
- should lie in the direction of the skin lines
- release of scar contractures
- multiple Z-plasties can be done to a linear scar
- multiple Z-p better than a large Z-p
- for extremeties constricting bands, release 1/2 at a time is better
Reconstructive ladder
Conclusion
沒有留言:
張貼留言
注意：只有此網誌的成員可以留言。