Radiofrequency (RF) surgery involves passage of radio waves at the frequency of 1.5 to 4.5 MHz. In case of skin lesions, the most commonly used frequency is 3.8 MHz. A radio-surgical unit consists of an electrode, a ground plate and a transformer. The radio waves generated, travel from the electrode tip to the lesion and return to the unit through the ground plate. Radio energy produces steam and vaporizes the tissue fluid resulting in cutting and coagulation of the tissues.
It generates very little heat as compared to conventional electro-cautery. This results in negligible collateral damage, resulting in faster healing and minimal scarring.
Uses of RF in dermatosurgery:
- Removal of skin tags, warts, seborrhoic keratoses, syringoma, trichoepithelioma.
- Removal of melanocytic naevi, telangectasias, early skin tumors.
- Skin biopsies
- Skin resurfacing (Radioabrasion) for acne scars, Rhinophyma etc
Dermabrasion is a surgery performed most commonly to improve scars due to acne, chicken pox, small pox etc. As the word implies it involves abrading the skin using motorized diamond dermabrader to eliminate superficial scars. It is performed using local anesthetic block. Immediately after the surgery the skin becomes red and swollen. There may be some pain, burning or tingling sensation that is controlled with analgesics. The swelling subsides in 3 – 5 days, a crust forms over the abraded area and the healing begins. The crust falls off and exposes the growing epithelium. It is mandatory to take strict sun protection precautions until the normal pigmentation returns completely, which may take 3-4 months.
Scars -whether they’re caused by accidents or by surgery- are unpredictable. Many variables can affect the severity of scarring, including the size and depth of the wound, the blood supply to the area, the thickness and color of your skin, and the direction of the scar.
While no scar can be removed completely, plastic surgeons can often improve the appearance of a scar, making it less obvious through the injection or application of certain steroid medications or through surgical procedures known as scar revisions.
Keloids are dark, thick, puckered, itchy clusters of scar tissue that grow beyond the edges of the wound or incision. Keloids occur when the body continues to produce the tough, fibrous protein known as collagen after a wound has healed.
Keloids can appear anywhere on the body, more commonly over the breastbone, on the earlobes, and on the shoulders. They occur more often in dark-skinned people than in those who are fair. Keloids are often treated by injecting a steroid medication directly into the scar tissue to reduce redness, itching, burning and to shrink the scar.
If steroid treatment is inadequate, the scar tissue can be cut out and the wound closed with one or more layers of stitches. A skin graft (see the section on skin grafting) is occasionally used, although the site from which the graft was taken may then develop a keloid. No matter what approach is taken, keloids have a stubborn tendency to recur, sometimes even larger than before. To discourage this, the surgeon may combine the scar removal with steroid injections, direct application of steroids during surgery, or radiation therapy. Or you may be asked to wear a pressure garment over the area for as long as a year. Even so, the keloid may return, requiring repeated procedures every few years.
Hypertrophic scars are often confused with keloids, since both tend to be thick, red, and raised. Hypertrophic scars, however, remain within the boundaries of the original incision or wound. They often improve on their own-though it may take a year or more-or with the help of steroid applications or injections.
If a conservative approach doesn’t appear to be effective, hypertrophic scars can often be improved surgically. You may receive steroid injections during surgery and at intervals for up to two years afterward to prevent the thick scar from reforming.
Burns or other injuries resulting in the loss of a large area of skin may form a scar that pulls the edges of the skin together, a process called contraction. The resulting contracture may affect the adjacent muscles and tendons, restricting normal movement.
Correcting a contracture usually involves cutting out the scar and replacing it with a skin graft or a flap. In some cases a procedure known as Z-plasty may be used. And new techniques, such as tissue expansion, are playing an increasingly important role. If the contracture has existed for some time, you may need physical therapy after surgery to restore full function.
Because of its location, a facial scar is frequently considered a cosmetic problem, whether or not it is hypertrophic. There are several ways to make a facial scar less noticeable. Often it is simply cut out and closed with tiny stitches, leaving a thinner, less noticeable scar.
If the scar lies across the natural skin creases (or “lines of relaxation”) the surgeon may be able to reposition it to run parallel to these lines, where it will be less conspicuous. (See Z-plasty). Some facial scars can be softened using a technique called dermabrasion, a controlled scraping of the top layers of the skin using a hand-held, high-speed rotary wheel. Dermabrasion leaves a smoother surface to the skin, but it won’t completely erase the scar.
Z-plasty is a surgical technique used to reposition a scar so that it more closely conforms to the natural lines and creases of the skin, where it will be less noticeable. It can also relieve the tension caused by contracture.
In this procedure, the old scar is removed and new incisions are made on each side, creating small triangular flaps of skin. These flaps are then rearranged to cover the wound at a different angle, giving the scar a “Z”pattern. The wound is closed with fine stitches, which are removed a few days later.
Skin Grafting and Flap Surgery
Skin grafts and flaps are more serious than other forms of scar surgery. They’re more likely to be performed in a hospital as inpatient procedures, using general anesthesia. The treated area may take several weeks or months to heal, and a support garment or bandage may be necessary for up to a year.
Grafting involves the transfer of skin from a healthy part of the body (the donor site) to cover the injured area. The graft is said to “take”when new blood vessels and scar tissue form in the injured area. While most grafts from a person’s own skin are successful, sometimes the graft doesn’t take. In addition, all grafts leave some scarring at the donor and recipient sites. Flap surgery is a complex procedure in which skin, along with the underlying fat, blood vessels, and sometimes the muscle, is moved from a healthy part of the body to the injured site.
Skin grafting and flap surgery can greatly improve the function of a scarred area. The cosmetic results may be less satisfactory, since the transferred skin may not precisely match the color and texture of the surrounding skin. In general, flap surgery produces better cosmetic results than skin grafts.