Reconstructive plastic surgery
Origin, definition, and healing process
The wound healing process leading to scar formation is a phenomenon involving a multitude of cells and humoral events, progressing through numerous phases that science has been studying and attempting to modulate for years. I have been working for many years in a Plastic Surgery Department where a considerable number of surgeries are performed annually. The outpatient clinics are teeming with patients who underwent surgery for various malformations, breast and skin tumors, burn sequelae, and traumas. Each person seeks an answer, a solution, advice, or a therapy that can mitigate the disfiguring outcome of the scar.
Clinically, scars are classified into:
– Normotrophic
-Hypertrophic
-Keloid
The stabilization process of a normotrophic scar involves an initial phase lasting a few weeks during which the scar appears normochromatic (matching the color of the surrounding skin). This is followed by a phase lasting a few months during which the scar becomes reddened and concludes with chromatic and textural normalization, even up to a year later. Pathological scarring processes lead to the formation of hypertrophic scars and keloids, considered the maximum and most unfavorable evolution of the hypertrophic event. The hypertrophic scar is a recent scar that is elevated compared to normal skin margins and has increased firmness. Although it retains some elasticity, its consistency is firm. The thickness of the epidermis can be thin, and the color is erythematous; it is often itchy. The keloid represents the pinnacle of hypertrophy. It is generally an aged scar, although in rare cases, keloid formation can occur rapidly. It is a thick, cord-like scar, with a hard, sometimes woody consistency. The color is red in fresh keloids but can transform into white in long-standing keloids. Patients typically complain of tension, a sense of constriction, occasional itching, and burning. Rarely, keloids, whose skin is superficially fragile, can ulcerate due to friction from clothing or scratching due to itching.
The formation of a pathological scar is influenced by countless factors:
- Individual reaction
- Racial background
- Surgeon’s delicacy during the procedure
- Medical and home treatments
Scars treatment
The treatment of scars is not a simple matter: even a normotrophic scar must be guided through the proper healing process to minimize the duration of redness and the accompanying discomfort. For the correct healing of a scar, the application of devices that accelerate the process is necessary. The therapy for hypertrophic and keloid scars is even more complex.
Sometimes the application of suitable devices helps resolve the hypertrophic state, while at other times, combined medical treatments such as cortisone injections or laser therapy, along with home treatments performed directly by the patient, prove indispensable.
The ideal home treatment should be effective, easy to apply, and cost-effective. For years, pharmaceutical companies have been researching devices for scar treatment or adjuncts to medical treatment.
Scientific literature now identifies three main factors that can positively influence the healing process:
- Compression
- Hydration
- Microclimate
Compression has been studied for years with sophisticated yet challenging-to-apply compressive dressings. Years of experience have led to the belief that the result is not proportional to the pressure applied: even modest compression can induce beneficial effects.
Hydration plays a fundamental role in keeping the epidermis and dermis soft, elastic, and preventing superficial microtraumas.
The last element is the microclimate: a humid (and healthy) environment accelerates the healing process. For this reason, research has focused on materials applied to the skin that can achieve this result.
For years, therapeutic products have been studied, but they were penalized for their poor manageability, cumbersome application, and excessively high cost. A home dressing, especially if the treatment needs to be prolonged, must be practical and easy to apply.
Cutting-edge studies, published in prestigious international journals, have identified polyurethane in self-adhesive sheets as the ideal material to meet the requirements of effectiveness and ease of use mentioned above.
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