Camouflage of Self-Inflicted Razor Blade Incision Scars with Carbon Dioxide Laser Resurfacing and Thin Skin Grafting

Ablative Laser Therapy of Skin

Laser skin rejuvenation was introduced in the mid-1990s. Early ablative laser devices relied on scanner technology that provided significant ablation and longer time on tissue treatments. These early treatments provided significant improvement in the appearance of the skin, but because of the longer treatment times and in some cases excessive treatment, complications such as scarring and hypopigmentation were significant. More recent advances in skin resurfacing technology have now minimized these risks providing certain key principles are observed. These parameters are reviewed in detail to improve the reader's ability to propose and execute proper skin resurfacing treatments.

Treatment of Self-Harm Scars: A Scoping Review

BACKGROUND

Self-harm scars are a consequence of deliberate self-injury, serving as a visual reminder for involved individuals. Patients often reach out to their providers seeking treatment for their scars. However, there is currently no standard for treating self-harm scars, because multiple options are being explored.

OBJECTIVE

A scoping review was conducted to identify and characterize the body of literature on different treatments for self-harm scars, including surgical, laser, and vitamin A management.

METHODS

Thorough literature searches were conducted in PubMed/MEDLINE, EMBASE, and CINAHL Complete. The search strategy was designed and implemented by a medical librarian.

RESULTS

Of 510 retrieved articles, 4 described laser treatments, 8 described surgical treatments, and 2 described vitamin A treatments.

CONCLUSION

A multidisciplinary approach is critical for the selection and outcome of the treatment of self-harm scars.

Efficacy of 2940 nm Multifractional Er: YAG Lasers in Self-inflicted Razor Blade Incision Scars

BACKGROUND

Deliberate self-harm (DSH) can be defined as self-inflicted injury without an intention to suicide, and it may result in scar formation with a particular shape.

AIMS

There is no treatment algorithm for DSH scars, nor is there a gold standard for the treatment of hypertrophic scars. Therefore, we aimed to share our experience with Er: YAG laser treatment of self-inflicted razor blade incision scars.

PATIENTS/METHODS

The study involved 18 patients with DSH scars treated with fractional ablative Er: YAG laser (MCL 31 Asclepion laser Technologies) between 2017 and 2020, with the parameters of 40 J/cm² , 300 µs, and 4 Hz. The sessions were repeated by increasing 10 joules in every session with 4-week intervals until reaching a maximum of 80 joules. The patients were evaluated retrospectively by two different dermatologists in terms of scar improvement over digital photographs taken before and 4 weeks after the treatment. Evaluations have been made based on a 4-point score (0:no change, 1:1%-25% mild, 2:26%-50% moderate, 3:51%-75% well, and 4:76%-100% excellent improvement).

RESULTS

After the third session, 90.9% of the patients showed a moderate improvement. After the fourth session, only 27.2% of the patients had a good, and 63.2% of the patients had a moderate improvement rate.

CONCLUSIONS

Er: YAG laser is a safe and effective treatment method for the hypertrophic scars induced by razor blades. Also, we believe that combined treatments with other treatment modalities will provide better results in DSH scars.

Treatment of Deliberate Self-harm Scars with Rotated Thin-skin Graft and Minced-skin Graft

Scars developing after wrist cutting (a deliberate action of self-harm) have various patterns and are difficult to treat. In addition, they can occur at anatomically prominent sites and are easily recognized as caused by self-harm; thus, scars can cause lifelong regrets. However, there are no standard treatment guidelines for wounds inflicted through self-harm. This study aimed to evaluate the effectiveness of our novel technique using 90-degree rotated skin grafts, which were thinly collected at a thickness of 250 μm from a wound site, together with minced-skin grafts.

Methods

Five regions on the forearm of 5 Japanese women (age, 19-29 years) were treated from July 2011 to April 2012. The skin at the scar site was cut with an electric dermatome at a thickness of 250 μm. The scar contained therein was excised, and the skin was rotated 90 degree and transplanted. The scar remaining in the dermis of the wound was resected and resurfaced. At the site where the skin graft was insufficient, the skin was processed into a minced shape and then transplanted (minced-skin graft).

Results

In all cases, skin grafting was performed. The scar was successfully camouflaged and transformed into a socially acceptable appearance. At the wound site, the skin texture was reproduced. Following skin grafting, nodules, pigmentation, and redness around the graft transiently occurred, which then disappeared over time. No scar contractures were observed.

Conclusion

A combination of thin-skin graft rotated 90 degrees and minced-skin graft is useful in camouflaging a wide variety of deliberate self-harm scars.

Nonsurgical Management of Hypertrophic Scars: Evidence-Based Therapies, Standard Practices, and Emerging Methods

Hypertrophic scars, resulting from alterations in the normal processes of cutaneous wound healing, are characterized by proliferation of dermal tissue with excessive deposition of fibroblast-derived extracellular matrix proteins, especially collagen, over long periods, and by persistent inflammation and fibrosis. Hypertrophic scars are among the most common and frustrating problems after injury. As current aesthetic surgical techniques become more standardized and results more predictable, a fine scar may be the demarcating line between acceptable and unacceptable aesthetic results. However, hypertrophic scars remain notoriously difficult to eradicate because of the high recurrence rates and the incidence of side effects associated with available treatment methods. This review explores the various treatment methods for hypertrophic scarring described in the literature including evidence-based therapies, standard practices, and emerging methods, attempting to distinguish those with clearly proven efficiency from anecdotal reports about therapies of doubtful benefits while trying to differentiate between prophylactic measures and actual treatment methods. Unfortunately, the distinction between hypertrophic scar treatments and keloid treatments is not obvious in most reports, making it difficult to assess the efficacy of hypertrophic scar treatment.

Deliberate self-harm scars: Review of the current literature

Introduction

Deliberate self-harm (DSH) can be defined as self-inflicted injury without suicidal intent. Treatment of DSH scars may involve a lengthy process and is not commonly treated in its initial stages to allow scar maturation. This review aims to assess the challenges behind scar treatment and outcomes of different surgical methods used to resurface DSH scars.

Methods

A review of the literature using CENTRAL, Cochrane, Medline and Embase from January 1990 to February 2016 was conducted. Our search strategy incorporated a combination of MeSH terms “Deliberate self-harm scars” and “self-inflicted scars”. Relevant bibliographies of literature were manually reviewed for additional resources. Non-English studies, non-human studies and studies prior to 1990 were excluded.

Results

A variety of techniques were described with including excision and full thickness skin graft reconstruction, excision with Integra resurfacing followed by split-thickness skin graft reconstruction, multiple excisions and laser therapy. A detailed summary of these findings is outlined. All studies reviewed show improved cosmetic outcome in treatment of DSH scars to some degree and no studies reported repeated self-harm.

Discussion

The literature surrounding the treatment of DSH scars is limited. There is a lack of use of reproducible and standardized scoring systems to compare between studies. The psychology behind DSH and their resultant scars adds another dimension of complexity beyond simple scar reconstruction.

Conclusion

When considering treatment, patient expectations must be carefully evaluated. Research in this area is lacking but understandable due to the nature of the self-harm.

Nonsurgical management of hypertrophic scars: evidence-based therapies, standard practices, and emerging methods

Hypertrophic scars, resulting from alterations in the normal processes of cutaneous wound healing, are characterized by proliferation of dermal tissue with excessive deposition of fibroblast-derived extracellular matrix proteins, especially collagen, over long periods, and by persistent inflammation and fibrosis. Hypertrophic scars are among the most common and frustrating problems after injury. As current aesthetic surgical techniques become more standardized and results more predictable, a fine scar may be the demarcating line between acceptable and unacceptable aesthetic results. However, hypertrophic scars remain notoriously difficult to eradicate because of the high recurrence rates and the incidence of side effects associated with available treatment methods. This review explores the various treatment methods for hypertrophic scarring described in the literature including evidence-based therapies, standard practices, and emerging methods, attempting to distinguish those with clearly proven efficiency from anecdotal reports about therapies of doubtful benefits while trying to differentiate between prophylactic measures and actual treatment methods. Unfortunately, the distinction between hypertrophic scar treatments and keloid treatments is not obvious in most reports, making it difficult to assess the efficacy of hypertrophic scar treatment.