More Effective Facial Scar Revision in Asian

Facial scar is very stressful for patients and physicians, especially in the case of non-parallel to relaxed skin tension line (RSTL). In general, for long facial scar not parallel to RSTL, Z-plasty or W-plasty has been performed to change the direction of scar or divide it into multiple segmented scar. These methods would be suboptimal, however, in the instance of Asian skin prone to scar formation. So, we experienced good results for scar revision through scar excision and solid subcutaneous- dermal repair to minimize scar widening despite of leaving linear type of scar. From July 2004 to March 2007, our methods were undergone for facial scar longer than 3cm in 84 patients. All scars were excised along the scar margin and subcutaneous tissue and dermis were repaired using single layer of subcutaneous-dermal stitch with 4-0 or 5-0 PDS to elevate wound margin 3-4mm higher than adjacent skin surface. Skin was repaired with 6-0 Prolene. The rate of satisfaction was over 89%(75 of 84 patients), the mean scar widening was 0.61+/-0.20 mm, and secondary operations were made in 3 patients. The Asian skin has some characteristics such as thick skin, increased melanin, energetic proliferation of fibroblast, and vigorous collagen formation, etc. Because of characteristics of Asian skin mentioned above, the linear pattern repair, technically easier than Z-plasty or W-plasty, would be superior to them in terms of the results. The essentially important point for scar revision in linear pattern is very strong subcutaneous-dermal repair to make elevation of wound margin enough for tolerating the skin tension and preventing scar widening.

2-Flap Palatoplasty for Troublesome Cleft Palate

PURPOSE: If the primary palatoplasty fails, mobilization of the mucoperiosteal flap will become difficult because of mucoperiosteal scarring. Likewise, cleft palate with wide gap makes it difficult to secure a sufficient mobilization of the periosteal flap. Authors have achieved satisfactory results with the operation of troublesome cleft palate using two-flap palatoplasty with dissection of neurovascular bundle from the mucoperiosteal flap. MATERIAL & METHODS: From January to December of 2005, Authors treated 3 troublesome cleft palates with two-flap palatoplasty with dissection of neurovascular bundle from the mucoperiosteal flap. Authors dissected pedicle wide enough to check it from operation field to make mobilization of flap easier, so that any restriction on mobilization of flap or wide gap of cleft palate can be overcome. Among the three patients, two patients are boys and one patient is a girl. Incomplete cleft palate is one case, and complete cleft palates are two cases. Two patients ware treated with cleft palate in the past. But, there still remained the cleft with marginal scarring. One patient has cleft palate with wide gap. RESULTS: All of the cleft palates were repaired with one- stage operation. There was no morbidity or complication reported such as flap necrosis, hemorrhage, palatal fistula and delayed wound healing. CONCLUSION: The excellence of two flap palatoplasty has proved by numerous authors, and it has been widely used as a primary palatoplasty. The two flap palatoplasty by our method is useful for mobilization of the flap. Dissection of neurovascular bundle from the mucoperiosteal flap creates sufficient mobilization, reduces injury on soft tissue, and eliminates tension when the cleft is closed. Also, no other donor site was needed. As two flap palatoplasty boasts many more advantages than those mentioned above, authors applied it to troublesome cleft palate as an alternative to other complicate operation methods to acquire good and positive results.