Occasionally extensive surgery is the best option for scar treatment.  The two most common forms of serious scar revision surgery are skin grafting and flap surgery.  These two procedures will take place in the hospital and require overnight stays.  The subsequent wounds may take up to a year to heal.

Skin grafting is a surgery involving transplanting healthy skin from another part of the body onto the scarred area.  Some connective tissue may be transplanted as well.  Skin grafting is usually a last option surgery.  Be sure and discuss other options with your certified board plastic surgeon.  The two main types of skin grafts are either full-thickness (FTSG) or split-thickness (STSG), depending on which type of skin transplant would be the most successful given the case.  The skin graft must also match the color and tint of the area in which it is being transplanted, for obvious cosmetic reasons.

When the new skin is placed over the scar, blood vessels and scar tissue form and take hold over the area.  Occasionally the new skin doesn’t take to the transplant, but this seems to be an infrequent occurrence.  Skin grafting also carries the risk of additional scarring in either the donor or recipient areas.

The donor site of the body (the area where the transplant is cut from) is most often one that is not usually exposed and is watched for infection for a few days after the surgery.  Some types of skin grafting involve using animal or biologic skin alternatives and have had limited but encouraging success.

Flap surgery is also a procedure that takes place in the hospital and involves several days of hospitalization for recovery and monitoring.  Skin flap surgery is similar to skin grafting except for the amount of tissue transferred.  Flap surgery involves a transplanting of skin and its accompanying fat, blood vessels, and occasionally muscle.  Blood vessels either remain attached to the donor area, or are surgically extracted and grafted onto the recipient area.

Flap surgery is necessary in cases where the recipient site is missing the required blood vessels or structure vital in making a successful skin graft.  Flap surgery “links” the donor blood supply through a variety of surgical techniques.

Both types of surgery have a good success rate in enhancing the quality of scarred tissue and skin.  The surgery is particularly helpful on scars that are more serious or deeply embedded in the skin.  Discuss all the options available with a board certified plastic surgeon before making a decision on whether or not flap surgery or skin grafting is right for you.