Surgical revision
Section snippets
Basic surgical techniques
In most cases, proper surgical technique at the time of the initial surgery eliminates the need for scar revision. Therefore, whenever the surgical outcome is less than ideal, the physician must critically analyze the surgical technique. What could have been done differently that would have resulted in a better scar? As the physician gains experience, fewer revisions should be needed; the lessons learned from previous “mistakes” are applied to the present surgeries. The following sections
Intralesional steroids
Hypertrophic linear scars, and bulky grafts and flaps, can be treated with intralesional corticosteroids [7]. Injections can be instituted at approximately 1 month postoperatively. A small amount (as little as 0.1 mL) of low-dose triamcinolone acetonide (Kenalog) at 5 to 10 mg/mL is injected into the scar; this dosage can be repeated monthly until the scar has flattened. This treatment will not affect the width of the scar, however. The injection is placed into the bulkiest region of the scar,
Summary
“If you do enough surgeries, you'll develop complications” is a valid adage. Surgeons therefore must learn from experience to reduce the chances of complications. Meticulous planning and technique will lead to superior results. Even the best surgeons, however, must confront scars and complications that are aesthetically unacceptable and need revision. When to act and how to act is important in surgical revision. Just waiting often may be the best treatment. Sometimes, surgical intervention is
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