title: The "Sea" should not be operated on in scar revision for "Island-Like" scars.
abstract: Scars developing on body surfaces not only restrict body movement, but are also problematic from a cosmetic standpoint. Hence, revision is conducted by removing the scar and re-suturing the resultant defects. In performing scar revision, care should be taken to prevent the re-sutured wounds from developing hypertrophy again. Scars often present a pattern where hard, red parts are separated by soft parts in between. As the hard and soft parts may be analogized as islands and seas respectively, we call this the "Island-Like" scar. Two strategies can be taken to treat scars of this type. The first is to remove the entire scar-including both hard and soft parts; the second is to remove only the hard parts and leave the soft parts untouched. The authors conducted a biomechanical study using finite element analyses and found that as a body moves, greater stresses occur in the peri-wound regions with the first strategy than with the second strategy. A wound's likelihood to develop hypertrophy increases as the stresses working on it increase. Hence, it is hypothesized that the second strategy carries less risk of the operated wounds developing re-hypertrophy than the first strategy. Based on this logic, in performing scar revision for scars consisting of hard and soft parts, it is recommended only to remove only hard parts and not to operate on soft parts in between.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Faculty of Medicine/Graduate School of Medicine, Kagawa University, Japan. Electronic address: nagasao@med.kagawa-u.ac.jp.
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Nagasao
authors.affiliation: Department of Plastic and Reconstructive Surgery, Faculty of Medicine/Graduate School of Medicine, Kagawa University, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Hamamoto
authors.affiliation: Department of Plastic and Reconstructive Surgery, Faculty of Medicine/Graduate School of Medicine, Kagawa University, Japan.
authors.forename: Motoki
authors.initials: M
authors.lastname: Tamai
authors.affiliation: Department of Plastic and Reconstructive Surgery, Faculty of Medicine/Graduate School of Medicine, Kagawa University, Japan.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Kudo
authors.affiliation: Department of Plastic and Reconstructive Surgery, Faculty of Medicine/Graduate School of Medicine, Kagawa University, Japan.
authors.forename: Toshiya
authors.initials: T
authors.lastname: Ensako
authors.affiliation: Department of Plastic and Reconstructive Surgery, Faculty of Medicine/Graduate School of Medicine, Kagawa University, Japan.
authors.forename: Tetsukuni
authors.initials: T
authors.lastname: Kogure
authors.affiliation: Department of Mechanical Engineering, Keio University, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Takano
authors.affiliation: Department of Plastic and Reconstructive Surgery, Faculty of Medicine/Graduate School of Medicine, Kagawa University, Japan.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Tanaka
mesh_terms: D000328:Adult; D002921:Cicatrix / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery*; D003198:Computer Simulation; D062109:Dermatologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D055119:Elastic Modulus; D005260:Female; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D008954:Models, Biological; D009068:Movement; D012008:Recurrence; D012867:Skin / Q000503:physiopathology*; D013314:Stress, Mechanical; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology*