Journal of Aesthetic & Reconstructive Surgery

Short Communication

Patients who have had skin cancer reconstruction often experience residual disfigurement. It takes an aesthetic and technical effort to restore form and function in these people. Surgical scar revision, dermabrasion, chemical peels, and laser resurfacing all rely on the skin's natural ability to renew over time in response to mechanical, chemical, thermal, and ablative stressors. Scars on the face are quite important to patients. Most patients measure the outcome of surgery mostly by their postoperative appearance years after enduring removal of a cutaneous cancer [1].

Scar revision and polishing skills are essential. Any full-thickness surgical incision leaves some sort of scar. As a result, meticulous planning of the basic reconstruction establishes the foundation for all later treatments. Many people are unaware that scar correction and flap refining require more artistry than they think. The recent restoration of Michelangelo's frescoes on the ceiling of the Sistine Chapel provides a spectacular aesthetic display of resurfacing. Scars that are long, continuous, and linear are more obvious than scars that are shorter and include more fragments. There is an increased risk of webbing when lengthy scars span concave areas, such as the medial canthus or the region from the jaw to the neck. Underlying muscular motion exacerbates the situation. Because the superficial and deep scar tissue layers might combine in deeper resection beds, soft tissue contracture is more likely. The degree of disordered, tethered scarring is also increased when there are various levels of injury [2].

Z-plasty is one of the most adaptable scar revision methods, and it is frequently used in skin cancer restoration. The traditional Z-plasty procedure entails the transposition of two neighbouring 60-triangle flaps. The initial direction of the scar is reoriented roughly 90 degrees after the flaps are translated and closed. To reduce scar length and protect surrounding healthy tissue, the M-plasty can be employed instead of a basic elliptical excision. However, the M-plasty has two limbs on each pole, which is a disadvantage. An M-plasty works by shortening the distance between the scar's midpoint and the excision's lateral edges. Contour-related issues abound in skin cancer restoration, and the complicated curvatures of the nose, medial cheek, and lip are particularly challenging to rebuild correctly. According to experienced surgeons, up to 75% of nasal alar reconstructions may require a third contouring phase to produce an alar groove. Dermabrasion should be done six to twelve weeks after the skin cancer defect has been closed or repaired. This period coincides to when collagen remodelling is in full swing. The lessons learned by the restorers of the Sistine Chapel ceiling are helpful to the reconstructive surgeon in this regard. Before beginning work, the restorers spent a significant amount of time examining Michelangelo's masterpiece and debating which treatments would be the most appropriate and which would cause unexpected harm [3-5].

In cases of soft tissue loss or contracture, tissue augmentation is recommended. Fat, for example, is good filler for improving the appearance of a soft tissue contour depression that may develop late after a hematoma. A few technical tidbits are beneficial. The flap's many Z-plasties should have arms that are about 5 mm long and lie at 30 to 40 degrees (tighter than the classic 60). Buried 5–0 PDS sutures persist longer and resist tissue retraction than other absorbable sutures. Skin reapproximation with vertical mattress sutures promotes eversion of wound borders and reduces the possibility of a depressed scar.

References

1. Clark JM, Wang TD (2001) Local flaps in scar revision. Facial Plast Surg 17: 295-308.
2. Alster T, Zaulyanov L (2007) Laser scar revision: A review. Dermatol Surg 33: 131-140.
3. Kukosa MS, Thomas JR (2009) Scar revision. In: Papel ID. Facial Plast Reconstr Surg 3: 61.
4. Leake DS, Baker SR (2007) Scar revision and local flap refinement. Elsevier 723-760.
5. Brenner MJ, Perro CA (2009) Recontouring, resurfacing, and scar revision in skin cancer reconstruction. Facial Plast Surg Clin North Am 17: 469-487.