How to hide self harm scars??
Answers
Answer:
Plastic and Reconstructive Surgery Global Open
Wolters Kluwer Health
Treatment of Deliberate Self-harm Scars with Rotated Thin-skin Graft and Minced-skin Graft
Kento Takaya, MD, Ruka Hayashi, MD, PhD, [...], and Kazuo Kishi, MD, PhD
Additional article information
Background:
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.
INTRODUCTION
Deliberate self-harm (DSH) is the physical harm of oneself without a clear suicide attempt. Cutting the wrist is recognized as an expression of emotional distress, dissociation, and posttraumatic stress disorder in self-harm.1 Globally, the incidence rates of DSH have been increasing in recent years, particularly in young adults and women.2 Most DSH scars are caused by the use of scissors, knives, and razor blades, among other objects, on accessible body parts such as the upper and lower limbs, abdomen, and chest. These scars present a variety of appearances such as multiple (mostly lateral) lines in one direction, linear and very thin or wide, atrophic, and flat or hypertrophic. In many cases, scars are closely spaced, and hypertrophic scars are relatively few. In the early stages, scars become red and then are gradually replaced by white and mature scar tissue. As previously reported, scars are observed in various patterns according to several different mechanisms of trauma. Therefore, it is difficult to evaluate scars by the existing evaluation or classification methods and to determine a treatment plan based on these results. Many studies have examined the motives underlying the involvement of patients in DSH. However, a few studies have been conducted on the treatment of scars. In addition, treatment guidelines for the management of pathological scars remain unmentioned.3–5
DSH scars are socially recognizable to others, especially when located on the forearm.6 Several studies have reported that DSH wounds (of all scar types) have the strongest negative impact on patients’ quality of life.7 Therefore, it is important to establish an appropriate treatment plan for DSH.
Conventional scar repair techniques and treatments are inadequate for treating DSH scars. Although laser treatment is sometimes effective,8 it could be time-consuming and occasionally produces unsatisfactory results. Microneedling, which involves creating small wounds in the dermis using a needle roller to induce wound healing, is frequently used to treat atrophic scars. However, a study has revealed that DSH scars do not benefit greatly from this treatment.9 Surgical approaches such as skin grafting and simple excision of scars or artificial dermis have been unsatisfactory due to the occurrence of new scars at the donor site and patchwork-like scar healing.10–12
Background
Self-harm injury has been traditionally associated with a wide range of mental health conditions including psychosis, depression and personality disorders (1). Alarmingly, self injury is increasingly being observed as a coping strategy for emotional distress amongst teenagers and young adults; this has been attributed to a number of ‘contagion factors’ including peer pressure, and risk taking behaviour promoted by popular media (2).
Clinical presentation
- There are a number of common features seen when patients present with self harm scars relating to (3):
- Bodily site, with the non-dominant arm most frequently affected followed by the lower limb and trunk
- Scar pattern, which tends to demonstrate multiple scars found in close proximity to each other
- Scar quality; most scars are ‘atrophic’ (i.e. contain decreased amounts of collagen) and have a depressed appearance
- Psychological manifestations; most individuals adopt a number of behavioural patterns in order to hide their scars and avoid being challenged in social encounters.
- Management principles
Team approach.
Patients need to be managed within a multidisciplinary setting comprising plastic surgery, psychology/psychodynamic therapy and other allied health care professionals able to address the complex needs of each individual. Close liaison with mental health services is important in order to help support patients with the internal conflicts that appear central to their self-harming behavior as well as addressing difficult emotions, which may arise during scar management (4,5).
Camouflage approaches.
The option of makeup products and medical tattooing is valid for patients wishing to reach a better colour match between the scars and surrounding skin (6). One of the main drawbacks with the camouflage approach is the temporary nature of results and need for repeat application of skin products and pigments to maintain the desired effect.
Needling. These techniques rely on creating small perforations in the skin using a device in order to remodel collagen and ‘blend in’ scars with the surrounding tissues (7). Appropriately chosen needling devices (i.e. long enough to reach the deep layer of the skin) need to be used for a satisfactory regenerative effect to occur.
Laser resurfacing. A number of different technologies can be used as standalone treatments including erbium fibre/carbon dioxide lasers and encouraging results have been reported in the literature (8,9). Over the last number of years, lasers are increasingly used in combination with surgery to maximise final scar outcomes.
Hey , hope this helps !!
Have a great day ~