Application of Bilateral De-epithelialized Hinge Flap to Correct the Deep Depressed Scar

ABSTRACT

BACKGROUND: Depressed scars are usually corrected using subcutaneous fillers such a dermal fat grafting or an autologous fat grafting. But, fillers are absorbed over time and cannot be appropriately used for the correction of large or deep depressed scars. Therefore, we tried new methods to correct challenging cases of deep depressed scars. METHODS: From 2005 to 2013, deep depressed scar were corrected in 10 patients. The location of the scars were as follows 6 neck, 4 lower extremities. Preoperative marking was done involving the scar on the skin in an oval shape including the long axis of relaxed skin tension line, and the epithelium of the scar was removed. Both ends of the dermal layer of the residual scar were dissected and then isolated from the subcutaneous layer of the adjacent skin. Then, we folded both ends of the flap like hinge flaps and thereby appropriately restored the depressed part of the dermal layer. And we directly closed skin for scar revision. RESULTS: All ten patients had a good result and satisfaction without complication, such as wound infection, dehiscence, at a mean follow-up of seven months. Correction of depression area made the depressed scar less noticeable. Moreover, the problems like donor morbidity, color and texture matching in case of using our techniques, are not issued. CONCLUSIONS: We folded residual scar tissue like a hinge flap in the correction of depressed scar. We obtained good outcomes and report our new methods and their outcomes with a review of literatures.