The dermal tube: a versatile tool in scar revision

Tethered scars are a common problem that can have functional and aesthetic consequences. Several approaches which use the dermis have been described for tethered scar correction. The objective of this report is to demonstrate the superior aesthetic outcomes achieved through the introduction of a new, simple dermal technique in scar revision surgery.

From August 2002 through to January 2006, 35 patients were operated on by the senior author for revision of tethered, sunken scars. All scars were considered to demonstrate sunken or depressed characteristics based upon clinical examination and photographic evidence. All patients were operated on by the same surgeon and using the same surgical technique.

All the patients were women (age range 17-64 years), with tethered scars affecting the breast (n=10), lower limb (n=5), upper limb (n=6), chest wall (n=4), laparotomy scars (n=8) and tracheotomy scars (n=2). Scars ranged in length from 4 to 30 cm (mean=12 cm). Follow up ranged from 2 to 24 months (median=16 months). At the 12 month follow up, patients were presented with their pre- and postoperative photos and asked to select the overall improvement in aesthetic appearance achieved as either: 'no improvement', 'improved' or 'marked improvement'. These were then ranked to scores of 0, 1 and 2, respectively (0=no improvement; 1=improved and 2=marked improvement). The responses from the questionnaire showed that the median score was 2 with 100% ranking >or=1. Thirty-two patients (91.4%) scored 2. There were no complications reported and the results at 12 months showed that restoration of volume to the scars had been maintained in all patients. To date, no one has had to undergo further revision and there have been no incidences of re-tethering.

The technique is simple to learn by even junior surgeons. Through following four distinct steps consistent and readily reproducible results are achieved.