Clinic of Aesthetic Medicine of Medical Doctor Edward Yurshevich
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Reconstructive surgery

Reconstructive surgery

Surgical correction of pathological scars

Understanding that you are absolutely different from any of the movie stars can poison life. The force of positive thinking is coming to help. It makes you find opportunities for wonderful transformations. Day comes and you tell yourself: “I am a charming woman!” And suddenly you see this purple-red and tuberous segment. Anomaly of the skin ... Unfortunately, after any skin damage remains a scar. In medicine it is called a cicatrix. At times, cicatrices have perverted forms — physicians name such skin conditions pathological, and the cicatrices — hypertrophic and keloid. Their treatment is a challenge, but perspective methods are there.

  • An ugly scar — the result of an operation.
  • After the removal of atheroma there is an ugly cicatrix.
  • Keloid after piercing.
  • A painful and convex cicatrix on the neck after a trauma
  • A scar is a cicatrix, a sign on the skin from the healed up wound. They are inevitable consequences of any open trauma or operation. There are many kinds, sub kinds and groups which they make, but the main thing is their gradation on normal and pathological ones. Pathological cicatrices: atrophic, hypotrophic, hypertrophic and keloid. Formation of such cicatrices is a common problem for dermatologists, surgeons, cosmeticians and patients.
  • Healing a wound is a synthesis of fibers of collagen and a process of its degradation (a return process). To make a normal cicatrix on the traumatized skin, the both processes must have an ideal balance with each other. Pathological cicatrices are formed if synthesis of collagen goes much quicker than its degradation. Strategy of treatment and its effectiveness in many ways depends on a correct recognition of a kind of cicatrix.
  • Predisposition to development of hypertrophic and keloid cicatrices has a hereditary character (more than30 factors revealed). But all the circumstances provoking the development of keloids have not been named till now. Only a few are known: a surgical intervention, a trauma, tattoo, vaccination, bites and stings of animals/insects, burns, piercing, breaks, as well as any inflammatory processes of the skin (acne, smallpox, etc.).
  • Pathological cicatrices can be formed at any age, but more often this problem arises at girls of 12-16 years and young women (20-26 years). Places of localization: cheeks, auricles, a neck, hands, a back, legs, mammary glands, an abdomen. Frequency of keloids formation cases is higher with women than with men.
The earlier, the better. Morally you should be ready that to get rid of a cicatrix is impossible — the trace from the skin damage remains for ever. It is very important to prevent the formation of an abnormal cicatrix. If it has already been generated the surgeon/dermatologist/cosmetician, who know the techniques of treating the skin pathologies, can improve its appearance considerably and make it less appreciable. The stage of a cicatrix formation of and when you addressed the doctor is very important (a cicatricial tissue forms within a month). In 3 months after a trauma/operation the cicatrix sprouts vessels, in a year nerves endings and becomes a part of your skin/organism. Do not postpone a visit to the clinic “for the future”, especially, if a “fresh” cicatrix does not heal, does not turn pale, and on the contrary, increases, reddens/becomes blue and is deformed. Early diagnostics of potential formation of a keloid or a hypertrophic cicatrix is a pledge of effective treatment. Today many methods for the salvation of the problem are used. What technology is optimal for you will be determined only during your visit to the doctor’s and after examining your cicatrix. The choice of treatment algorithm also depends on the location, the area and depth of a cicatrix. If you wish to get rid of a pathological cicatrix (hypertrophic, keloid), you should be ready for a long treatment — about one year.
After diagnosing the cicatrix, the problem is solved in a complex. A unified therapeutic model cannot exist a priori. An algorithm of treatment is always chosen by the doctor individually. To salve the problem many things are important: localization, depth of the damage, the size, character of the trauma and the age of the patient. Keloids are subdivided into “young” (from 3 months till 5 years) and “old” (5-10 years), accordingly the programs of treatment are different. The most effective and correct therapy are complex techniques used to prevent the growth of keloid tissue. There are many of them: compression therapy, silicone bandages (humidifying the cicatrix, compression of capillaries, reduction of inflammation and synthesis of collagen), cryosurgery, surgical excision, injections of medical preparations (corticosteroids) into the cicatrix tissue, electro or phonophoresis of medicines, magnetic and laser therapy. If a compression therapy and silicone bandages have appeared ineffective, hormonal therapy — injections of hormones into the cicatrix area (once a week) for resolving the grown pathological tissue are prescribed. Surgical treatment of keloids is indicated when they extensively grow, and a local hormonal treatment was not effective.
А surgical excision of the cicatrix, skin plastics, gradual cultivation of healthy skin near the cicatrix for subsequent plastics, the moved skin flaps... The surgeon reduces the damaged area. But the problem cannot be salved only by a surgical excision of the keloid. Because of the keloids propensity to relapses, right after the cicatrix excision we start preventive measures — combinations of various methods (on indication). It can be therapy by interferon, laser polishing, mesotherapy, physiotherapy. Use of these methods enables to reduce an excessive scar making and to prevent relapses. In our clinic there are universal lasers of the German company Asclepion Laser Technologies GmbH which we use for dermabrasion of skin. The laser beam helps to make the cicatricial tissue even with the skin surface and to make a cicatrix normal (normotrophic). After a laser correction medicines (preventive measures against infection) are prescribed and also medical cosmetological procedures for improvement of feeding and humidifying the skin are performed. Right after healing the area of polishing, the treatment is added/proceeds with other methods of cicatrices correction.
For estimation of the performed treatment efficiency and because of a high risk of relapses of keloid cicatrices, we recommend out-patient treatment/preventive measures, as well as monitoring of the cicatrix condition within 1-2 years.
Keloid trauma can contribute to occurrence of erosion and a local bacterial infection.
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