Revising Non-Transplant Scars

Dr. Rassman,

This is a bit of a tangent. I had 3 surgeries with you folks between 97 and 2000, and I continue to be pleased with the results. It appears it will be quite some time before I need more work done. When I researched different groups, you folks stood head and shoulders above the rest in terms of professionalism and especially how much research you had done. It was clear you were at least as interested in advancing the art as being successful from the business end.

Thus I am interested in your opinion on scar revision. I have two 6-7 inch scars – one on my elbow from nerve transposition surgery, another one that is horseshoe shaped above my armpit from reattaching a torn pec from a snowboarding mishap. Both scars spread kind of badly, such that at spots they are about as thick as my index finger. Apparently both those spots tend to be high tension, which causes the spreading. Both incisions were sutured with plain stitches or staples, not any interior stitches.

I’ve been doing web research on and off for several years, but I haven’t been able to convince myself that there is any group or technique that has a good chance of making a big improvement. What are your thoughts about the state of the art of scar revision? Perhaps this is a new area of study to apply your innovation. :)

When a person has stretched scars on many parts of their body, I often think of diseases that produce this problem. You should first be sure that you do not have any of these diseases such as Ehlers-Danlos Syndrome which is a connective tissue disorder. You are correct that some scars that come from wounds which are located in areas where the skin is stressed, can stretch in any person, even those without a connective tissue disorder. Plastic surgeons are often good at dealing with changing the way forces are applied to these stretched areas. One common procedure for managing scars is a process called a Z-plasty, where a linear scar is change to a Z type scar so that the forces do not oppose each other to stretch the scar. In the scalp, there are other factors far too complex for me to cover in a blog response here.