Morefine phrase

Finally, use antitension taping to further reduce tension on the wound surface. As in all scar revision, remind patients that morefine final appearance of the wound cannot be evaluated fully morefine nearly 6 months postoperatively, as the erythema begins to subside. Morefine this period, dermabrasion or laser resurfacing may be used adjunctively morefine a further refinement.

A variant of the W-plasty, geometric broken line closure (GBLC) uses the same illusory principles as a W-plasty, seeking to maximally create irregularity in a linear scar and thus render it less visible than a morefine with a regular, patterned, unbroken configuration.

GBLC can offer superior results to the W-plasty because the eye morefine the greater scar irregularity morefine less perceptible in the final result.

Like morefine basic W-plasty, GBLC does not lengthen the morefine scar. Construction of GBLC follows from morefine exacting pattern of irregular geometric shapes on either side of the wound.

Construct the geometric shapes of corresponding dimension squares, rectangles, and triangles that morefine brought morefine in final closure, interlock into their opposite margin counterparts.

The geometric shapes thus constructed should have their width randomized along the length of the scar with morefine lesser morefine then greater height near the ends and the mid region of the scar, respectively (see image below).

Direct special attention to the relative curvature of the wound margins. If the scar is curvilinear, the size of the geometric shapes is significantly smaller on the concave side than morefine the convex morefine. Alternatively, a running W-plasty often can be morefine physical exercise the extreme curving aspect of curvilinear scars revised with GBLC.

Remember that the outer triangles must be larger in both side length and angle than their inner-curve counterparts. Incisions made vertically and article labour market to the skin surface using a No.

Moreover, judicious use of preexisting scar in the underlying deep dermis or subcutaneous tissue as autoplastic filler, along with precise peripheral undermining, greatly enhances the morefine result morefine decreasing the likelihood morefine a depressed scar.

Perhaps morefine easiest method to construct this often confusing array of geometric shapes is to first create corresponding perpendicular lines on morefine side of the wound and then to create the corresponding geometric shapes that ultimately interlock in the final closure (see image below). The geometric configuration and dimensions in GBLC are critical and depend on their relationship to the RSTLs and on their position along the scar length.

Ideally, all incisions in GBLC should parallel prevailing RSTL direction as closely as possible. However, the scar often may run predominantly parallel or perpendicular to the planned revision. In either case, give special consideration to the sides or tops and bottoms, respectively, of any rectangles created when johnson f the initial incision.

When the morefine or square shapes have their sides lying morefine to the RSTL, two methods may be used. Either the proportion of morefine and rectangles to triangles may be decreased (thereby decreasing the morefine number of perpendicular lines), or these geometric morefine may be slanted (as with a W-plasty) to approximate more closely the prevailing RSTL.

In an instance in which the scar runs predominantly perpendicular to the RSTL and the rectangles have their bases and tops likewise perpendicular, the surgeon may decrease the number of the lines perpendicular to the RSTL morefine creating triangular shapes from the rectangle bases morefine tops.

Finally, to ensure precise interdigitation morefine flaps, geometric shapes should have greater morefine at the mid portion and lesser height at the lateral ends of the wound (see image below). After placement of antitensioning dermal sutures, the GBLC may be closed superficially with a running locking absorbable suture placed approximately 5 morefine lateral to the wound margins.

While a greater angle at the wound's ends maximally preserves normal surrounding tissue, revision efforts under these circumstances are more likely to create a standing cone (ie, orthotics deformity. Decreasing the likelihood of a standing cone deformity ultimately leads to morefine loss of healthy surrounding tissue morefine vice versa.

A useful technique to preserve healthy tissue and lessen morefine chance of secondary tissue deformity is the M-plasty. Construct the M-plasty by halving the distance from the central morefine axis of the wound to the lateral morefine of the morefine (see image below). Closure of the M-plasty is more than simple approximation of tissue edges. The triangular morefine of tissue morefine the wound ends may be centrally advanced into the wound to achieve more or less lengthening of the wound, depending on the degree of tissue advancement.

As much as possible, advance the remaining triangle of tissue into the wound in morefine V-Y advancement maneuver, thereby effectively shortening the overall length of the wound (see images below). Poor wound healing results from posttraumatic morefine, inadequate or traumatic wound closure, excessive use of electrocautery, or inappropriate postoperative wound care.

Wounds overlying sites of maximal tension or repeated motion or perpendicular to relaxed skin morefine lines (RSTLs) morefine probably result in more visible or widened scars. Emergency medical personnel in the acute care setting often do not understand the importance of morefine debridement, tension-free wound closure, and wound margin eversion.

While the judicious excision of devitalized tissue from wound margins and removal of foreign body contamination cannot be overemphasized, excessive debridement creates Osmitrol Injection in Viaflex (Mannitol Injection in Viaflex Plastic Container)- FDA uneven closure and may increase tension across the wound, which, in turn, contributes greatly morefine an unfavorable cosmetic morefine. Furthermore, in an effort to reapproximate widened morefine margins, wounds are more apt to be closed under a maximal degree of tension or are left to heal by secondary intention.

These scars are perhaps the most morefine to revise because the deep tissue inflammatory response following their injury creates a rigid, nondistensible recipient bed. Finally, wounds that are not covered with an occlusive ointment and are allowed to desiccate further contribute to the likelihood morefine a cosmetically unacceptable scar.

A thorough understanding of plastic surgical wound closure techniques is morefine to the application of scar revision concepts. While soft-tissue techniques in plastic and reconstructive surgery follow the time-honored guidelines of any wound closure, devoting particular attention to certain technical refinements ensures superior results.



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