Introduction
A scar is nothing dangerous but refers to the body's natural mechanism of wound healing. Scar revision or treatment of scars by any method requires expertise in the techniques and a thorough understanding of the facial anatomy, psychological risk factors associated with injuries, and wound healing. The doctor needs to understand that the patient perceives the scar as damage to the skin. It is emotionally challenging for a person to live with scars throughout their life. Hence, scar revision and secondary reconstruction procedures have become popular after skin cancer surgeries.
What Is a Scar?
A scar is a mechanism by which the body knits together or heals its tissues after surgery or injury. Wound healing is a multistep process that involves complex procedures, scar formation being one of them. Whenever a person gets injured, some amount of blood flows from his body. This blood usually contains blood cells or platelets that clump together to form a clot that seals the wound and stops bleeding. Next, the immune system comes into action and initiates inflammation to allow the body to fight infections. Certain body cells accumulate and start rebuilding the skin. After a few days, the tissues present in the surrounding skin contract and form a scar. This scar usually persists for a year or more and looks different from normal skin.
What Are Scar Revision and Secondary Reconstruction?
As the name suggests, scar revision is a procedure that aims to alter the appearance of scars. In addition, scar revision aims to restore the functions of the body parts affected due to scars. However, one needs to remember that scars can never be completely removed. Scar revision is completely an individual's choice and should not be done to fulfill others' desires. Secondary reconstruction is mostly done for skin cancer for aesthetic and functional implications. Though it can be done by multiple treatment approaches, the choice varies according to the patient's defects. Hence, the patient must be screened for conditions like diabetes mellitus, hypertension, heart disease, and the use of anticoagulants.
What Is Skin Cancer?
Skin cancer is a condition characterized by the uncontrolled growth of skin cells in the areas exposed to the sun. However, it can also occur in areas that are not exposed to direct sunlight. The most common skin cancers are squamous cell carcinoma, melanoma, and basal cell carcinoma. Patients can reduce their chances of skin cancer by avoiding excess sun exposure. Hence, one needs to undergo a clinical examination to get treated for skin cancer. The signs and symptoms of skin cancer are listed below:
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Presence of small, smooth, and waxy bumps on face, neck, and ears.
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Pink or brown-colored lesions are visible on the arms and legs.
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Presence of multiple sores on the skin that have a depression in the middle.
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Certain areas on the skin look like scars.
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Presence of pink or red nodules.
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Scaly or rough lesions that might cause bleeding or itching.
How Is Scar Revision Surgery Done for Skin Cancer?
The steps of the scar revision surgery are listed below:
1. First, the patient is counseled regarding the risks and benefits associated with the procedure.
2. Next, the patient is given a consent form to confirm that the patient is willing for the procedure and is not under any peer pressure.
3. On the day of the procedure, the patient will be administered general or local anesthesia to make the surgery painless.
4. Surgery outcomes depend on the type, size, and location of scars. Sometimes, a single technique is enough to provide significant improvements, whereas, in some situations, multiple surgeries might be required. The scar revision techniques include the following:
Topical Treatment - The doctor might use gels or external compression methods to help in healing and wound closure. These procedures aim to treat pre-existing scars and skin discoloration.
Injectables - Dermal fillers can be used for depressed or concave scars. The results usually last from several months to years, depending on the patient's condition. In most cases, the treatment must be repeated to maintain the outcomes.
Surface Treatments - These treatments aim to improve the appearance of scars. Surface treatments smoothen the irregularities and can alter the superficial layers of the skin. The surface treatments options include:
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Dermabrasion or skin resurfacing procedure.
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Laser therapy can change the skin surface and allow the formation of new and healthy skin.
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Chemical peeling improves the skin texture and removes irregularities.
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Bleaching agents can be applied topically to alter the skin's complexion.
5. The next step after the surgery is the closure of skin incisions. Scars can be closed directly or through the layered closure method. The first layer of the skin usually requires sub-dermal closure with absorbable or non-absorbable sutures. Finally, the layers build up, resulting in scar closure.
6. Tissue substitutes can be used if adequate amounts of healthy tissues are not present for scar closure. It is most likely done for the closure of burn scars.
What Happens During the Recovery?
Healing after a scar revision surgery is a multistep procedure characterized by swelling, discomfort, and discoloration for one to two weeks. The healing will continue for several weeks, and the scar will gradually fade. Patients with dermabrasion, laser treatments, or chemical peeling are likely to experience the same, along with sensitivity. The patient must not get worried as the surgery results are long-lasting. However, one must remain patient as it might take a year for the scar to disappear and the actual results to become apparent.
How Is Secondary Reconstruction Done for Skin Cancer?
Skin cancer is one of the most prevalent cancers known to affect humans. Skin cancer is characterized by lesions that can be treated using noninvasive methods in the initial stages. However, the lesions that penetrate the deeper tissues must be reconstructed or treated surgically. In addition, patients undergoing skin cancer surgery have to bear the brunt of facial deformities, which is emotionally challenging. Hence, reconstruction surgeries aim to restore the original facial form and features, thereby giving the patient clear and scar-free skin. Primary repair or primary healing is one of the most common methods done after skin cancer surgeries. During this procedure, the wound edges are usually closed with sutures. In contrast, healing by secondary intention allows the wound to heal naturally without the use of sutures. In addition, full or partial-thickness skin grafts can be used.
Conclusion
Skin cancer alters the appearance of a person's skin to a large extent. As a result, patients tend to get depressed with the scars left after the surgery. Hence, secondary reconstruction and scar revision surgeries aim to restore the anatomy of the skin's functionality. Patients who wish to undergo this surgery can consult their doctors to learn more about the advantages and disadvantages.
