Definition & Overview
The skin is the body’s first line of defense against various elements and pathogens. However, it is not immune to damages. In fact, being the protective cover of the human body makes it vulnerable to cuts, burns, and diseases.
The body has a mechanism that allows it to repair small wounds or scrapes on its own. However, this seems to be inadequate in cases of large wounds, such as those caused by invasive surgical procedures, burns, and lacerations, among others. Such can not only damage the superficial and deeper layers of the skin but also typically lead to the formation of unsightly scars.
Having large scars can seriously affect a person’s confidence, especially if clothing can’t conceal them. However, they can be made less conspicuous with skin tissue rearrangement. The procedure, which can be performed several ways using a variety of techniques (e.g., punch revision and scar revision), aims to reduce the appearance of scars by rearranging the tissue.
In some cases, such as those involving hyperkeratotic lesions, the old scar is surgically removed and the resulting wound is sutured in a way that will create a less visible scar. However, if the damage is too large, a tissue rearrangement procedure, such as adjacent tissue transfer, may be necessary. This involves the removal of healthy skin tissue (grafts) from other parts of the body and using it to cover the damaged skin. The procedure is standard in the management of severe burn cases.
Who Should Undergo & Expected Results
Skin tissue rearrangement is ideal for patients with large lesions, scars, burns, and those scheduled for foreign body removal. It is specifically recommended for those who have damaged skin on body parts that cannot be hidden by clothing. However, patients who simply do not like the appearance of the scar may also opt to undergo the procedure.
The surgery is also usually performed on breast cancer patients who have undergone a mastectomy, a procedure that removes the breast to eliminate cancer cells. Skin tissue rearrangement is often performed post-surgery to cover the resulting wound so it will heal faster.
Patients who undergo skin tissue rearrangement can expect a significant improvement in the appearance of their skin. However, this doesn’t mean the scar will be totally eliminated. As such, patients are informed ahead of time of the possibility that minimal scarring may still be visible after the procedure.
How Does the Procedure Work?
Skin tissue rearrangement is performed through surgical methods and requires the use of anaesthetics. The amount of anesthetics used is decided based on the type of surgery to be performed and if the patient will need to be asleep during the process.
In many cases, burn patients are put to sleep for the procedure while those who do not require the use of skin grafts can remain awake. The affected area will be administered with a local anesthetic to create a numbing effect so the patient does not feel any pain.
For the graft procedure, the surgeon will start by removing the damaged skin using a wide excision technique. A healthy skin from the donor site is then harvested and transplanted to the recipient site. All the wounds are then closed using sutures. In some cases, patients may need to undergo several incision and drainage procedures while in recovery to prevent infection and fluid buildup as well as hasten the healing process.
The donor site where the skin graft was harvested will be treated and protected until it is completely healed. Patients are then informed that even when the wounds heal properly at the transplanted site, scarring may still be slightly noticeable after the suture removal process to manage their expectations.
It may also be possible to use skin that is directly adjacent to the damaged portion (skin flap procedure). This is similar to a skin graft but instead of harvesting the skin from another part of the body, the harvested skin is right beside the affected area. The main benefit of this technique is that the harvested skin will remain attached to the body, which means that blood supply will not be interrupted. This allows the flap to heal faster.
Possible Risks & Complications
Because skin tissue rearrangement involves repairing damaged skin by creating more damage to other parts of the body, there is a possibility that complications may develop. These include developing an allergic reaction to the medications and anaesthetic used during surgery or recovery. There is also a risk of the wound not healing as expected. If an infection develops, the patient may need to undergo another type of treatment to manage the infection before it spreads throughout the body.
Patients, particularly those who undergo the procedure for cosmetic purposes, are warned about these risks to help them weigh their options. If doctors feel that the risks outweigh the possible benefits (such as in cases where the patient has another medical condition like diabetes), patients are advised to forego the procedure unless medically necessary (such as in the case of burn patients suffering from soft tissue atrophy).
There is also a risk that the procedure may fail due to several reasons, which may include wound mismanagement, the formation of a hematoma, and poor skin healing resulting in a more visible scarring.
Nevertheless, skin tissue rearrangement is generally safe with high success rates. Complications are often managed well or avoided altogether as long as patients comply with all the postsurgical instructions given by the doctor.
It is worth noting that there have been significant improvements in the technologies used in skin tissue rearrangement. Such technologies include the use of artificial skin, which significantly reduces the amount of damage caused by creating a skin graft or flap.
Adnan Prsic, MD;”Scar Revision”; http://emedicine.medscape.com/article/2250161-overview?pa=3mMVO54MyLqHSveQCnNoWk6kiK7tNKi4MWwp0wr9S3G%2BbPsgtZwP7SpJ2GrSKLYr8tkq%2B4FUMwvnopEGjQ93%2BDCgTLadDjW30XNFYmyptyk%3D
San Antonio Cosmetic Surgery;”Burn Reconstruction”; http://www.sanantoniocosmeticsurgery.net/burn-reconstruction/ Encyclopedia of Surgery;”Skin Grafting”; http://www.surgeryencyclopedia.com/Pa-St/Skin-Grafting.html