eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Cosmetic Surgery
Scar Revision: Multimedia
Updated: Jun 30, 2009
Multimedia
![]() | Media file 1: Scar revision. Four main facial lines that delineate the prevailing direction of relaxed skin tension lines (RSTLs). |
![]() | Media file 2: Scar revision. Classic Z-plasty composed of two 60° angles. |
![]() | Media file 3: Scar revision. Transposition of flaps in Z-plasty. |
![]() | Media file 4: Scar revision. Completion of 60° Z-plasty. Note lengthening of the scar and how the central limb now lies nearly perpendicular to original orientation in Image 3. |
![]() | Media file 5: Scar revision. Elastic model demonstrating Z-plasty before flap transposition. |
![]() | Media file 6: Scar revision. Transposition of flaps in 60° Z-plasty. Note beginning of lateral tissue distortion as the central limb lengthens. |
![]() | Media file 7: Scar revision. Final closure of elastic model in 60° Z-plasty. Note directional change of the central limb and extreme lateral tissue distortion. |
![]() | Media file 8: Scar revision. Relationship between angle and central limb lengthening in Z-plasty. Note how the larger angle corresponds to a greater increase in length. |
![]() | Media file 9: Scar revision. Properly oriented Z-plasty for a scar traversing the cheek-lip groove with lateral limbs directed nearly parallel to relaxed skin tension lines (RSTLs). |
![]() | Media file 11: Scar revision. Compound 4-flap 45° Z-plasty. |
![]() | Media file 12: Scar revision. Completion of compound 4-flap 45° Z-plasty. Note significant tissue distortion at ends of wound. |
![]() | Media file 13: Scar revision. Serial Z-plasty applied to ovoid defect. |
![]() | Media file 14: Scar revision. Serial Z-plasty applied to ovoid defect. |
![]() | Media file 15: Scar revision. Serial Z-plasty applied to ovoid defect. |
![]() | Media file 16: Scar revision. Size and number differential between W-plasty triangles to ensure corresponding fit between inner and outer wound curvature. |
![]() | Media file 18: Scar revision. W-plasty is drawn carefully. |
![]() | Media file 19: Scar revision. W-plasty is excised while maintaining the blade perpendicular to the skin's surface. |
![]() | Media file 20: Scar revision. A completed W-plasty. Note lack of lateral tissue deformation. |
![]() | Media file 21: Scar revision. Excision following design of geometric broken line. |
![]() | Media file 22: Scar revision. Closure of geometric broken line revision technique. |
![]() | Media file 24: Scar revision. Central scar with bilateral M-plasty. |
![]() | Media file 25: Scar revision. A wound following excision of central scar. Note how M-plasty design conserves otherwise discarded healthy surrounding tissue. |
![]() | Media file 26: Scar revision. M-plasty final closure. |
![]() | Media file 27: Scar revision. Diagrammatic representation of M-plasty closure with advancement of the tip into the defect by horizontal mattress suture technique. |
![]() | Media file 29: Scar revision. Incision parallel to direction of hair follicle reduces likelihood of alopecia. |
![]() | Media file 30: Design of W-plasty in cheek scar revision. |
![]() | Media file 31: Scar revision. W-plasty in scar parallel to orbicularis oris. |
![]() | Media file 32: Scar revision. Utility of curvilinear W-plasty in forehead scar revision. Note intentional angulation of triangular sides to lie within relaxed skin tension lines (RSTLs). |
![]() | Media file 33: Scar revision. Planning for W-plasty through eyebrow. |
![]() | Media file 34: Scar revision. Completed W-plasty for scar traversing the eyebrow. |
More on Scar Revision |
| Overview: Scar Revision |
| Treatment: Scar Revision |
| Follow-up: Scar Revision |
Multimedia: Scar Revision |
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| Further Reading |
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References
Frodel JL Jr. Dealing with the difficult trauma and reconstructive surgery patient. Facial Plast Surg Clin North Am. May 2008;16(2):225-31, vii-viii. [Medline].
Donelan MB, Parrett BM, Sheridan RL. Pulsed dye laser therapy and z-plasty for facial burn scars: the alternative to excision. Ann Plast Surg. May 2008;60(5):480-6. [Medline].
Martins A, Trindade F, Leite L. Facial scars after a road accident--combined treatment with pulsed dye laser and Q-switched Nd:YAG laser. J Cosmet Dermatol. Sep 2008;7(3):227-9. [Medline].
Skouge JW. Subcutaneous island pedicle flap with Z-plasty: a cosmetic enhancement. Dermatol Surg. Dec 2007;33(12):1529-32. [Medline].
Stiefel D, Schiestl C, Meuli M. Integra Artificial Skin((R)) for burn scar revision in adolescents and children. Burns. May 26 2009;[Medline].
Borges AF. Principles of scar camouflage. Facial Plast Surg. Spring 1984;1(3):181-90. [Medline].
Borges AF. Prognosis of scarring in wounds. In: Borges AF. Elective Incisions and Scar Revisions. Little Brown & Co;1973.
Borges AF. Relaxed skin tension lines. In: Borges AF. Elective Incisions and Scar Revisions. Little Brown & Co;1973.
Borges AF. Z-Plastic scar revision. In: Borges AF. Elective Incisions and Scar Revisions. Little Brown & Co;1973.
Cohen IK, Beaven MA, Horakova Z, Keiser HR. Histamine and collagen synthesis in keloid and hypertrophic scar. Surg Forum. 1972;23(0):509-10. [Medline].
Cohen IK, Keiser HR, Sjoerdsma A. Collagen synthesis in human keloid and hypertrophic scar. Surg Forum. 1971;22:488-9. [Medline].
de Oliveira GV, Nunes TA, Magna LA, et al. Silicone versus nonsilicone gel dressings: a controlled trial. Dermatol Surg. Aug 2001;27(8):721-6. [Medline].
Goslen JB. Physiology of wound healing and scar formation. In: Thomas JR, Holt GR, eds. Facial Scars: Incision, Revision and Camouflage. Mosby-Year Book;1989.
Goslen JB. Wound healing for the dermatologic surgeon. J Dermatol Surg Oncol. Sep 1988;14(9):959-72. [Medline].
Kischer CW, Shetlar MR. Collagen and mucopolysaccharides in the hypertrophic scar. Connect Tissue Res. 1974;2(3):205-13. [Medline].
Klopp R, Niemer W, Fraenkel M, von der Weth A. Effect of four treatment variants on the functional and cosmetic state of mature scars. J Wound Care. Jul 2000;9(7):319-24. [Medline].
Knapp TR, Daniels RJ, Kaplan EN. Pathologic scar formation. Morphologic and biochemical correlates. Am J Pathol. Jan 1977;86(1):47-69. [Medline].
Maguire HC. Treatment of keloids with triamcinolone acetonide injected intralesionally. JAMA. 1955;192:325.
Montagna W, Parakkal PF. The Structure and Function of the Skin. 3rd ed. NY:. Academic Press;1974.
Rockwell WB, Cohen IK, Ehrlich HP. Keloids and hypertrophic scars: a comprehensive review. Plast Reconstr Surg. Nov 1989;84(5):827-37. [Medline].
Saski GH, Krizek TJ. Biology of tissue injury and repair. In: Giorgiade NG, et al, eds. Essentials of Plastic, Maxillofacial and Reconstructive Surgery. Lippincott Williams & Wilkins;1987.
Schmidt A, Gassmueller J, Hughes-Formella B, Bielfeldt S. Treating hypertrophic scars for 12 or 24 hours with a self-adhesive hydroactive polyurethane dressing. J Wound Care. May 2001;10(5):149-53. [Medline].
Thomas JR, Holt GR. Facial scars. In: Facial Scars: Incision, Revision and Camouflage. St. Louis:. CV Mosby Co;1989.
Toriumi DM, Raslan WF, Friedman M, Tardy ME. Histotoxicity of cyanoacrylate tissue adhesives. A comparative study. Arch Otolaryngol Head Neck Surg. May 1990;116(5):546-50. [Medline].
Webster RC, Davidson TM, Smith RC, et al. M-plasty techniques. J Dermatol Surg. Nov 1976;2(5):393-6. [Medline].
Further Reading
Clinical guideline
Management of burns and scalds in primary care.
New Zealand Guidelines Group - Private Nonprofit Organization. 2007 June. 120 pages. NGC:005962
Clinical trials
Juvista in Scar Revision Surgery of Disfiguring Scars (Revise)
Exploratory Study of the Efficacy and Safety of Juvista 250ng When Administered Following Excision of Ear Lobe Keloids
Related eMedicine topics
Scar Revision (Dermatology)
Laser Revision of Scars
Z-Plasty
Facial Burns
Wound Healing, Nerve
Keloid and Hypertrophic Scar
Keywords
scar revision, cosmetic wound revision, scar repair, cosmetic skin repair, Z-plasty, classic Z-plasty, multiple Z-plasty, serial Z-plasty, W-plasty, running W-plasty, zig-zag plasty, M-plasty, geometric broken line closure, GBLC




































































Multimedia: Scar Revision