It is very common for children to fall down and sustain lacerations (medical term for cuts) over the face and limbs.
It is very common for children to fall down and sustain lacerations (medical term for cuts) over the face and limbs.
Although most wounds can heal with wound care and time, the aim of suturing a laceration is to oppose the edges as perfectly as possible. This is especially needed if the cut is deeper and underlying fat is exposed. A scar is inevitable — thus the aim is to make it as thin and inconspicuous as possible.
Plastic surgeons have unique knowledge of facial anatomy and are challenged every day to make scars beautiful. Using microsurgical suturing technique and magnifying loupes, the best possible result can be achieved.
Toilet and suture (T&S) can be performed in the Emergency Department under local anaesthesia. A gentle and patient approach will minimise trauma for the young patient. For larger and deeper cuts, this can be done under sedation or general anaesthesia in the operating theatre.
The procedure may typically be covered under accident insurance or hospitalisation insurance, depending on the terms of one’s insurance policy.
Plastic surgeons are often involved in the assessment and treatment of skin lesions and subcutaneous lumps. Although the majority are benign (non-cancerous), early evaluation is vital if there are suspicious symptoms or signs.
These include large size or increase in size over a few months, irregular appearance (shape or colour), pain or bleeding. If it has not changed at all in years, it is usually benign.
If in doubt, it is better to seek the advice of a medical professional. A biopsy may sometimes be required to ascertain the diagnosis.
As an alternative to excision biopsy (complete removal), superficial skin lesions such as benign moles can be vaporized using a carbon dioxide laser. The small crater that forms heals over a few days, forming a flat pink spot.
Sun avoidance, sunblock and sometimes anti-pigmentation creams are critical to avoid post-inflammatory hyperpigmentation, when the spot can turn dark brown due to increased melanin activity.
Depending on the depth of the mole, a small raised scar can result if the deeper dermis was entered, although the scar typically flattens with time.
Although absorbable sutures can be used for the external layer, using non-absorbable sutures reduces the scar formation and fibrosis that arises from absorption of the suture.
After sutures are removed at 5-7 days, the scar will initially appear raised and pinkish for the first 3 months. The scar tissue will be remodelled from the third month onwards, resulting in scar flattening and improvement.
Scar management with sunblock, silicone scar cream, massage, injections and lasers will optimise the result.
The most common subcutaneous lumps are lipomas or epidermoid cysts.
A lipoma is a non-cancerous fatty tissue growth under the skin. It should be removed if it is very big, growing, painful or if it bothers the patient. An epidermoid cyst is another non-cancerous nodule filled with keratin material.
As these lumps can occur over the face or noticeable areas, it is important to make the incision as small as possible. The resultant scar can also be reduced with gentle, meticulous suturing technique and early post-operative scar management.
Conversely, a lump can be suspicious if there are signs such as an irregular edge, fixation to deeper tissue or growth over time. Although less common, these should be evaluated as early as possible.
If a skin cancer is detected, wider removal with clear margins is required. This is because surgery offers the best chance of “clearing” the tumour and lowers the risk of it coming back.
The resulting defect (or hole) tends to be bigger and closing the wound directly may not be possible. Surrounding structures such as the eyelids or nose may be distorted by too much tension. A flap of surrounding tissue is then designed and “turned in” to close the hole, in what is termed “local flap closure”.
Using lasers and injections, the area can be blended in with the surrounding skin. Further minor revisions are sometimes needed to make the results even better.
