Scar Revision mayo stand and back table surgery setup

Scar revision surgery is a procedure performed to improve the appearance of a scar. The surgery involves removing the original scar tissue and creating new flaps of skin to cover the area, which can help reduce the size and visibility of the scar. The procedure is often performed using a “Z” or other geometric shape pattern to ensure the new scar is less visible. Scar revision surgery can help improve the patient’s self-esteem and quality of life.

Positioning
Depends on scar location. Supine, lateral, and prone are all options.

Drapes
This will also depend on where the scar is located. In general you will need folded towels or utility drapes and either an extremity drape or a laparotomy drape

Step 1: Making the Incision
Once the patient is under anesthesia, the surgeon will use a 15 or 10 blade on a #3 knife handle to cut and remove the original scar tissue. Depending on the size and length of the scar, either a 15 or 10 blade on a #3 knife handle will be used.

Step 2: Creating the Flaps
After the original scar is removed, the surgeon will create two arms off of the main incision, forming a “Z” shape. Small Metz or Tenotomys scissors will be used to loosen the skin underneath the incisions. Adson forceps with teeth or DeBakeys are also used to hold the skin in place. Skin hooks are commonly used in this step to retract the triangular skin. Small Weitlaners may also be used to hold the skin.

Step 3: Loosening the Flaps
The flaps will be lifted and transposed to cover the original scar, and the skin will be loosened with Metz or Tenotomys scissors. The surgeon will use Adson forceps with teeth or DeBakeys to hold the skin in place while moving the flaps.

Step 4: Closing the Incision
Once the flaps have been loosened and transposed, the surgeon will carefully close the incision in layers. The deepest layer will be closed with an absorbable suture such as Vicryl. The skin will commonly be closed with 4-0 Monocryl or Nylon.

The Surgery Sparknotes

1. Make incision using a 15 or 10 blade on a #3 knife handle.
2. Create flaps forming a “Z” shape using Metz or Tenotomys scissors and Adson forceps with teeth or DeBakeys, and skin hooks or Small Weitlaners.
3. Loosen the flaps and lift them up to cover the original scar.
4. Close the incision in layers: deepest layer with absorbable suture such as Vicryl, skin with 4-0 Monocryl or Nylon.