Since I posted a thread and a scar case last week, I have gotten several calls asking what we do to minimize donor strip scarring.

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First we like long thin strips, which minimize the amount of actual scalp stretching required to close the donor site. Our average donor width is about 1.25 to 1.75cm. I have seen other folks who go way up on width, to keep from needing to extend the scar around the head. That certainly puts more tension on the wound edges, a factor that has been shown to increase scar width in lots of studies. We prefer minimized tension and a longer scar. If the scar is going to be thinner, most folks would gladly have a longer scar.

Our second way of minimizing scar width is with the use of deep sutures. This is common for facelift incisions where it is critical to have a thin scar; and is common in areas where there will be significant wound tension due to the size of skin being removed (for example think of a skin cancer on the cheek)--the cancer and some surrounding margin are removed and for most people there is not a lot of extra skin on the cheek, so deep sutures are used to take the force of this stretch off of the skin--which would react by spreading or hypertrophying--and put that tension on the deep layers.

The same is true in the scalp. With deep sutures the wound tension is placed in the subcutaneous tissues and the skin lies together. Skin sutures or staples thereby just keep the epidermis aligned during early healing. All of the real work is done by the deep sutures. We use deep sutures which dissolve in a few months, minimizing suture extrusion.

Lastly, we encourage scar creams, gentle massage, and a scar check at 6 weeks. While these techniques can't guarantee an invisible scar, they do consistently result in very thin and acceptable scars in our hands.

Dr. Lindsey www.lindseymedical.com Reston, VA

Yes I agree but there have been some that have a reaction due to the internals that resulted in an infection along with a wide scar after resolution.
Do you know why some peoples body react negatively with the internal sutures.

No idea why some folks react and others don't. I had TWINS that I operated on 5 years ago. One extruded all of the deep sutures, and although it was a nuisance for a few weeks, a fine scar resulted. The other extruded no sutures. One would think that nearly identical genetics would have reacted similarly.

For us, suture extrusion occurs in about 1 in 30 patients, often only on one suture, not 4 or 5. We use dissolvable sutures, so any problems should be completely resolved quickly and it is quite easy to just remove any problematic suture.

To achieve a nicer scar, we feel it is well worth it.

Thanks for the comment.

Dr. Lindsey www.lindseymedical.com Reston VA