Papers of The 6th Japan Scar Workshop

13. Improved Gordon Buck Method for Depressed Linear Scar of the Face - Information on No Stitch Mark Forceps and Diagonal Needle Holders

Masashi Itoh
Department of Plastic and Reconstructive Surgery, Kantoh Rousai Hospital

1) Most depressed linear scars of the face indicate that the patient suffered from a traffic accident, especially that involving the front windshield glass.
2) Most deeply depressed linear scars are fixed to the subdermal basal tissues. For the scar to be excised completely, the lesion should be able to reconstruct the depression caused by the vertical scar contracture after a common surgical treatment by the casualty operator.
3) Operation: the upper part of the linear scar is excised partially. From the deep corners of both the side defects, bilateral incision is carried out obliquely downward and outward with the surrounding fatty tissues, such that the deep part of the linear scar remains intact to act as buttress tissue. The adjoining tissue thus mobilized is approximated upon this buttress with subcutaneous sutures for less tension. Finally, the skin closure is performed using special instruments that prevent stitch marks.
4) Follow up and result: the lesion will be elevated considerably immediately after the operation, however, this will improve gradually to a flattened surface without stitch marks. The 3M tapping should be applied until all signs of redness disappear from the lesion within several months. If the patient suspects that keloids will form, irradiation (Electron Beam 5 Gy×2 times) would be effective after the operation, and the final result will be seen within 1-2 years.
5) The special instruments are as follows:
a) No stitch mark forceps (designated by Masashi Itoh)
b) No stitch mark diagonal needle holder (designated by Eiji Itoh)
Both instruments are simple to use and are very useful.
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