SURGICAL EXCISION - This is a procedure in which the surgeon shaves down and cuts out scar tissue to reduce the size of the scar. This technique is most commonly used on large scars that cannot be treated adequately with medications or other nonsurgical means. When excision is done in stages, it is referred to as "serial excision." This is performed if the area of the scar is too large to remove at one time without distorting nearby skin.
FLAPS, GRAFTS, AND ARTIFICIAL SKIN.- Flaps, grafts, and artificial skin are used to treat contractures and large areas of scarring resulting from burns and other traumatic injuries. When there is not enough skin at the site of the injury to cover the incision made to cut out and remove the scar tissue, a skin graft (thin layer of skin) from another part of the body carefully matching colour and texture is placed over the excision site. The graft tissue itself is harvested preserving its own blood supply so that the donor tissue can successfully ‘bed in’ to its new location.
Z-PLASTY AND W-PLASTY. Z-plasty and W-plasty are surgical techniques used to treat scarring contractures and help to minimize the visibility of scars by repositioning them along the natural lines and creases of the skin. They are not usually used to treat keloids or hypertrophic scars. With a Z-plasty, your surgeon makes a Z-shaped incision with the middle line of the Z running along the scar tissue - the flaps of skin formed by the other lines of the Z are rotated and sewn into a new position that reorients the scar about 90 degrees. In effect, the Z-plasty minimizes the appearance of the scar by breaking up the straight line of the scar into smaller units. A W-plasty is similar to a Z-plasty in that the aim is to minimize the visibility of the scar by turning a straight line into an irregular one. The surgeon makes a series of short incisions to form a zigzag pattern to replace the straight line of the scar. The primary difference between a Z-plasty and a W-plasty is that a W-plasty does not involve the formation and repositioning of skin flaps.