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Am J Emerg Med. 2017 Dec;35(12):1804-1809. doi: 10.1016/j.ajem.2017.05.055. Epub 2017 May 29.

Usefulness of direct W-plasty application to wound debridement for minimizing scar formation in the ED.

Author information

1
Department of Emergency Medicine, Gimpo Woori Hospital, 160, Gamam-ro, Gimpo-si, Republic of Korea.
2
Department of Medical Education, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
3
Department of Emergency Medicine, Chungbuk National University Hospital, 776, Sunhwan-ro, Seowon-gu, Cheongju, Republic of Korea.
4
Department of Emergency Medicine, Chungbuk National University Hospital, 776, Sunhwan-ro, Seowon-gu, Cheongju, Republic of Korea; Department of Emergency Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea. Electronic address: cpr@chungbuk.ac.kr.
5
Department of Emergency Medicine, Chungbuk National University Hospital, 776, Sunhwan-ro, Seowon-gu, Cheongju, Republic of Korea; Department of Emergency Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea.
6
Department of Emergency Medicine, Chonnam National University Medical School, 160, Baekseo-ro, Dong-gu, Gwangju, Republic of Korea.
7
Department of Surgery, Chungbuk National University Hospital, 776, Sunhwan-ro, Seowon-gu, Cheongju, Republic of Korea.

Abstract

PURPOSE:

A suture line placed with the same direction as the relaxed skin tension line leads to good healing, but a suture line with over 30 degrees of angle from the relaxed skin tension line leads to longer healing time and more prominent scarring. W-plasty is widely used to change the direction of the scar or to divide it into several split scars. In this study, we applied W-plasty to patients with facial lacerations in the emergency department.

METHODS:

From June 2012 to December 2014, 35 patients underwent simple repair or W-plasty for facial lacerations. Patients in the simple repair group underwent resection following a thermal margin, and the W-plasty group was resected within a pre-designed margin of W-shaped laceration. We assessed prognosis using the Stony Brook Scar Evaluation Scale (SBSES) after 10 days (short-term) and six months (long-term), respectively, following suture removal.

RESULTS:

Among 35 patients, 15 (42.9%) underwent simple debridement and 20 (57.1%) underwent W-plasty. In the W-plasty group, there was no difference between short-term and long-term follow-up showing high SBSES, but in the simple debridement group, long-term follow-up SBSES significantly decreased. W-plasty SBSES was higher than simple debridement at short-term as well as long-term follow-up.

CONCLUSION:

We experienced good results of direct W-plasty application at six-month long-term follow-up. Therefore, W-plasty application is more effective in reducing scar appearance than a simple debridement method for facial laceration patients with an angle of 30 degrees or more to the relaxed skin tension line.

KEYWORDS:

Debridement; Laceration; Scar; Suture; W-plasty

PMID:
28587949
DOI:
10.1016/j.ajem.2017.05.055
[Indexed for MEDLINE]

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