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Plastic and Hand Surgery Plastic and Hand Surgery Plastic and Hand Surgery

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Whenever a cut occurs in the skin, the body heals the wound by forming a scar. Many factors determine the quality of a scar. A major factor is the genetic makeup of an individual. Different individuals have different skin types and their ability to form scars varies.

Scars take up to 2 years to mature. Over that time they usually become pale and flat. Some scars are problematic. They can remain raised, unsightly, pitted or contract and pull on the skin to form tight bands.

Keloid Scars

A keloid scar is a scar that grows outside the original wound margin. They are raised and may be itchy or irritable. They occur more commonly in a dark skin type. Patients may present with a keloid scar following any incident which results in a cut in the skin.

This may follow an accident, ear or other body piercing and sometimes following surgery. Certain areas of the body form less good scars and these include the centre of the chest and tip of the shoulder. Surgical scars that cross skin creases do not tend to heal as well as those placed within the skin crease.

Keloid scars are difficult to treat. Some patients respond to a series of steroid injections at 6 weekly intervals into the scar itself. This is used in combination with pressure and silicone. There is a recurrence risk. Other treatments include skin grafts and radiotherapy.

Hypertrophic Scars

These are scars that become red, raised, itchy and lumpy. They grow within the wound margin and do not extend out into normal tissue. Red haired individuals with pale freckled skin tend to have a predisposition to this type of scar. Treatment involves massage and moisturisation, pressure, silicone and steroid injections.

Burn Scars

These scars can cause functional problems as well as cosmetic ones. Sometimes tight bands can form across flexion creases. This may cause difficulty in straightening the elbow, knee or fingers for example. Various plastic surgical techniques can be employed to release these scars. It may mean rearranging the scar itself or bringing in new tissue in the form of a skin graft or flap.

Scar Revision

It may (although not always) be possible to improve the appearance of a scar by undertaking a procedure called a scar revision. Depending on the size and location of the scar, the procedure is usually performed under local anaesthetic. Those factors in scar formation that are controllable are addressed to optimise wound healing and the final resulting scar.

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Contact Miss Mary O’Brien for more information on Cosmetic or Hand Surgery.

The British Association of Aesthetic Plastic Surgeons
The Royal College of Surgeons of England Bapras The British Society for Surgery of the Hand

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