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Chapter Five Accidents Emergency Care Minimizing Scarring Scar Repair Excision Scar Transformation Dermabrasion

Scar Transformation

Breaking up the scar, our third camouflage technique, involves using a combination of geometric cuts that we refer to as Z-plasties, W-plasties and M-plasties. The letters, Z. W and M resemble the shape of the cuts; plasties is a plural word derived from the Latin and Greek words for plastic, as in plastic surgery. (There are other, less commonly used cuts also referred to by their shapes, such as the “V to Y advancement” technique. The names are simply shorthand to quickly describe the kind of cut we are going to male.) Once the skin has been geometrically cut, we swivel it around to change the direction of an existing scar.

As an example, if a patient had a five-centimeter horizontal scar across the cheek, we could make it less noticeable by breaking it up with a “running W-plasty” cut. This is a series of W-plasties, slightly angled, that transform the scar from a single line into small segments of scarring. Some of the W-plasties could be made paralled with existing facial lines, further camouflaging the scar. We might mix in a couple of M and Z plasties to break up the scar even more. The end result would be a rough patch of skin with tiny asymmetrical scars, instead of an unbroken gash. Many factors affect the quality of the end result, including the type of skin a patient had to begin with, but I’ve seen this technique work wonders on some thin to medium, thick-skinned people.

Breaking up a scar is also an effective way to treat some the special situations I mentioned above - problem scars like the “trapdoor” phenomenon or webbing in the corner of the eye. A web is created when a scar contracts during healing. The challenge is to ease the pulling caused by contraction and flatten the scar. A Z-plasty cut solves the problem by allowing the skin to be rearranged in a geometric fashion. We are able to increase the distance between two points by cutting in a Z-shape, and this allows the scar to lie flat.

The “trapdoor” phenomenon requires a combination of techniques. This is because a trapdoor involves two types of scarring: the linear scar that outlines the edges, and the scarring underneath that is contracting and causing the area to bulge out from the surrounding skin. We start by cutting Z-plasties into the corner of the scar, then pulling up the skin to “undermine” beneath the scar and on the outside of the trapdoor. The trapdoor area collapses and the Z-plasties allow us to sew the skin flat.

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