Dr Parker talks about Scars from Skin Cancer and Mohs Surgery

Speaker 1: One of the things I enjoy the most about plastic surgery is the complex and creative thinking process that goes into fixing a lot of different types of holes that we see on people's bodies and faces. There's a lot of different things we can do. For example, on the nose there's probably a hundred different ways we can fix a spot on the nose. Basically kind of go through an algorithm, some people call it the reconstructive ladder, where we basically start with kind of the base basic procedure first. What's the simplest thing we can do to fix this hole? If that gives a great result, then that's what we're going to go with. Some times we have to go further up the ladder. Some times we have to go to a more complex procedure. Ultimately, we're trying to find the simplest procedure that gives the best result.

There's a number of factors that go into creating the best scar possible. First of all the selection of the appropriate technique to use. Secondly is the way you actually handle the skin when you're closing it, trying to be non-traumatic, and trying to gently pull the skin together.

Some factors are out of our control. For example, the location of the scar. For example, scars over the joints like the knee or the shoulder or scars in the center of the chest will often tend to heal more thick than other locations. I'm going to show you a demo to kind of illustrate how this works. You'll see here a circle that I've cut out. As I try to put stitches in to close the circle, you can see that the ends are starting to pucker and bulge. This is an unfortunate result that will typically not go away. These dog ears, as we call them, will often persist for years and years and years, and often require surgical revision to reduce them. 

Now I'm going to show you what we typically do for a standard hole closure. Typically, we take that hole, we remove triangles, what we call Burow's triangles on both sides of the hole, and pull the hole together. This creates more of a football shape hole so that when we close it, the ends do not pucker. The shorter the Burow's triangles, the likely you might have some persistent bulging. The longer the Burow's triangle, the longer the scar but the less likely you'll have bulging.