Correction of Pin Tract Scar

External Fixator and Distractors are commonly being used for management of complex fractures. A good alignment and  bony union is the main concern of the orthopaedician. Prolonged placement of pin causes epidermal in growth and also tethering of scar to underlying bone. Though cosmetic appearance may not be the prime concern for the doctor, patient do complain of unsightly scar over limbs. Also a tethering of skin to bone or muscle does not permit gliding of skin leading to pain during movement. Thus correction of these scars are necessary.

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There are a few simple procedures which can be performed under local anesthesia.

Subcision

Subcision is used to break up fibrous bands that cause rolling scars. This technique is performed under local anaesthesia by inserting a needle (Nokor  Needle 18G) under the skin that is parallel to the skin surface. If scarred area is large or adherent to bone an incision is made 1cm away from the scar and a scissor is used to undermine below the scar. Once the skin is free from bone hematoma formed under the scar organises elevating the scar.

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Nokor Needle

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Multiple W plasty.

  • Outline the scar with multiple zig zag incisions.
  • Remove the epidermis from the scared area( De epithelize)
  • Deepening of the incision through the dermis to create a dermal island.
  • Undermine around the scar
  • Closure of the wound over the dermal island

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Lipo Filling

Following Subcision of scar fat harvested by liposuction can be infiltrated below the scar to elevate it and prevent recurrance.

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