Continuous tension reduction technique in facial scar management: A comparison of W‐plasty and straight‐line closure on aesthetic effects in Asian patients

Abstract

W‐plasty is a very popular scar excisional revision technique. The core of the technique is to break up the scar margins into small triangular components, so as to cause light scattering and make the scar less noticeable. However, due to skin tension, facial incision scars tend to spread. Applying W‐plasty alone cannot achieve the ideal repair effect of facial scars. In this study, we proposed a scar revision technique combined W‐plasty with continuous tension‐reduction (CTR) technique to improve the appearance of facial scars. Sixty patients with facial scar were comprised in this retrospective study. Scars were assessed independently using the scar scale before and at 12‐month follow‐up. Clinical results showed a significant difference in scar appearance between different groups at 12‐month follow‐up. Vancouver scar scale (VSS), visual analogue scale (VAS) scores, and patient satisfaction were significant better in W‐plasty and CTR than other groups at 12‐month follow‐up. No severe complications were reported. The application of the tension offloading device provides an environment where the tension is continuously reduced, which could greatly decrease tension on the surgical incision. Combined with W‐plasty, this technique could significantly improve the scar's aesthetic appearance.

Biomechanical explanation of W-plasty effectiveness using a finite element method approach

“…W-plasty has been applied since decades in facial plastic surgery and remains the first-line treatment modality for repairing malformed facial scars. Its ‘broken-line’ or ‘accordion’ appearance allows the scar to break down into smaller triangles, with at least one side parallel to a poorly defined relaxed skin-tension line (RSTL), which causes light scattering and leads to less conspicuous scars 5 .…”

“…Wang et al has found W-plasty to be more effective when combined with continuous tension-reduction, i.e. tension offloading devices such as steri-strips 5 .…”

Treatment and Improvement of Healing after Surgical Intervention

“…Other studies investigated the adhesion of devices to discharge mechanical stress from the surgical incision [23,28,41]. These mechanisms have been shown in animals to be associated with transcriptional downregulation of inflammatory pathways [45] and have obtained benefits in other similar research, helping to heal and improving their aesthetic appearance [46,47].…”