These are some questions that patients and lay public and even some doctors ask frequently. Kindly go through this section, our question may be answered here. You may also send specific queries by filling out the form under ‘Ask Your Questions’.
I have a few scars on my body due to old injury. Is it possible to remove the scars by plastic surgery?
It is possible to improve many scars but is not possible to remove them completely. Scars, once formed, cannot be made to disappear. It is a fundamental biological fact that human beings cannot heal a breach in the skjn without a visible scar. So far no drug or technique has been invented to make scars disappear.
Why so some people get good scars while some suffer bad scars? Is it related to the surgical technique?
Most important factors that influence the scar appearance are: color and skin type of the person, racial type, age, direction of the scar [particularly on the face], amount of skin tension in that area and whether or not there has been tissue loss and finally the surgical technique of wound closure. Notice that the first three most important factors are neither in the surgeons control nor the patient’s. It comes as a surprise to many that different skin types scar differently but all plastic surgeons know this. Many of the other doctors are also not aware of this face, so your GP may not know this.
Skin types are classifies as 6 types called Fitzpatrick types. Type 1,2 usually scar very well while types 5,6 are at risk of bad scars. Further younger persons produce worse scars compared to those of 50+ age! Any wound that took long to heal or got infected usually produces bad scars.
What methods may be used to IMPROVE scars?
Plastic surgeons have several techniques and tricks in their repertoire to us on scars and improve their appearance. The choice of method and ultimate success depend on numerous factors starting right from the circumstances of the initial injury to the skin type and racial type of the person. Within these limitations, plastic surgeons can still improve many scars by doing scar revision surgery, Z and W plasty to change the direction of the scar, by using laser, silicone sheets and compression garments. Everything from the type of suture to the tension on the skin repair is controlled to give the most optimum result.
When is the best time to see a plastic surgeon for scar improvement?
Any time is a good time although the surgeon may decide to wait for the optimum time before doing the scar revision. If you think that an accidental wound has not been well repaired and you would like to have a plastic surgical repair, then it is best to see the plastic surgeon within 3 days of the earlier stitching. The PS may wither agree that the job is satisfactory or may choose to remove those stitches and re-do the job straightaway. This can ensure a good scar. For practicl reasons all injuries cannot be repaired by a plastic surgeon nor is it necessary. Cosmetically sensitive areas can be seen by a plastic surgeon in the first few days to guide the treatment further towards an optimum result.
We have heard of glue like superglue. Why don’t we repair all wounds with that? It will avoid stitching, especially in kids.
In an ideal world, there should be something like, particularly for children; but the currently available glues have a lot of limitations. Glue can only be used ofr superficial cuts that can be passively joined together and held in place for 20 seconds while the applied glue dries. There should be no excess blood flowing. Such conditions are not always available especially in a crying child. Badly applied glue can delay the wound closure by several weeks.
What is the best first aid for a minor burn?
For every burn, the first few seconds and minutes are crucial. This is when the heat is penetrating the skin layers and causing progressive death of the layers. IMMEDIATE cooling by water is MANDATORY to immediately halt the spread of heat. This is MORE IMPORTANT than any cream, antiseptic or medicine. The water should preferably be cool but time should not be wasted looking for ice or cold water. The nearest available water at room temperature can be used. It does not have to be sterile, only clean. Tap water is adequate. The part should be continuously cooled for 5-10 min before applying a cooling gel pad or clean vegetable oil or paraffin oil. Only then one needs to look for sterile dressings and take the victim to medical attention.
When is skin grafting needed for a burnt area?
Your treating doctor is the best person to decide that. IN general a second degree burn will heal with dressings in 2-3 weeks but a deep second degree and third degree burn needs skin grafting. Burn wounds heal from the skin residue left behind in the area, usually the roots of the hairs. If this source of new cells has already been destroyed by the burn or by subsequent infection, that burn cannot heal from within. Such cases need skin grafting from another part of the body. That part called the donor area will heal by itself.