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Scarring is believed to be secondary to prolonged inflammation and can be minimized by rapidly closing a wound primarily, skin grafting, or other techniques. 35. What treatment options are available for hypertrophic scars? Pressure garments, topical silicone sheeting, adjunctive use of insoluble steroids, and reexcision may improve hypertrophic scars. In general, simple reexcision and closure is a realistic solution if the cause of the scar was poor wound closure, inadequate support from wound tension, prolonged inflammation from infection, foreign bodies (excess suture), or delayed epithelialization.

24. What is the optimal angle for Z-plasty design? The optimal angle is 60°. Angles significantly less than 60° do not achieve sufficient lengthening, defeating the purpose of the Z-plasty and resulting in flap narrowing and vascular compromise. Angles much greater than 60° produce significant tension in the adjacent tissue, preventing transposition of the flaps. 25. What are the indications for multiple Z-plasties? A similar degree of lengthening can be produced by a single Z-plasty and multiple Z-plasties, because the total length of the central limbs of multiple Z-plasties can equal the length of the single Z-plasty.

Radiated fibroblasts show decreased proliferation and collagen synthesis, leading to diminished deposition of extracellular matrix. Lymphatics are likewise damaged, causing edema and poor clearance of infection in healing tissues. 29. Why does edema impair wound healing? In normal tissue, each cell is only a few cell diameters away from the nearest capillary and receives oxygen and nutrients by diffusion. Edema impairs wound healing through several mechanisms. First, the additional extracellular water increases diffusion distances, resulting in lower tissue pO2.