Surgical treatment of after scars excision wounds in children

Abstract

Introduction: The ability of the primary wound healing, and hence the probability of formation of scar with favorable characteristics depends on how modern principles of surgery are implemented. Materials and methods: During last 3 years (2013-2015), in PMSI "Emilian Cotaga" Clinic, in the Department of burns, plastic and reconstructive surgery, 162 surgeries of scar excision and plasty with local tissues were performed.Results and discussions: Principles of surgical treatment of wounds are: (1) Preservation of blood supply in the tissue forming the wound wall at a satisfactory level. Solving a specific surgical task is always Associated with the separation of tissues, and in plastic surgery very often with the formation of skin-fat flaps. In cases when tissue blood flow does not have a distinct axial direction, the alimentation of the flap is considerably reduced. (2) Accurate approximation of the wound walls, especially of the skin edges. This presumes the presence of a relatively smooth and adequate, in terms of dimensions, to each other wound surfaces, which allows closing the wound or without cavities formation with a smooth surface in the area of sutures. (3) Fixing the wound edges in tight contact during the entire period of scar formation. (4) Minimal action of the sutures on the skin surface. If separate sutures are applied too tight, next to the suture develop small foci of necrosis, and the scar take a rail road appearance. This significantly impairs the external characteristics of the scar, and often makes it impossible for effective correction. Conclusion: It is necessary to apply the stitches so that after the operation would not remain any significant cavities in the wound that will increase the risk of infection. For this, first, wound layers must be precisely connected to the corresponding layers (muscle, fascia, subcutaneous fat, skin). The second important principle of wound closure: skin edges should be very close approximated by applying deep, subcutaneous stitches. This allows to close the wound with cutaneous sutures with a minimum tension, and thus with the lowest exposure of skin surface to sutures.