Treatment of Deliberate Self-harm Scars with Rotated Thin-skin Graft and Minced-skin Graft

In our solitary facility, common DSH scars on the lower arms (5 forearms: 4 flexors, 1 extension) in 5 Japanese females aged 19– 29 years (mean age, 23 years) were dealt with separately in between July 2010 and also April 2012. People that had received medical treatment for an acute physical or emotional problem, had psychological trouble, were expecting or breastfeeding, had a history of skin infections, had malignancies, or used immunosuppressants were omitted from the therapy. The typical time between treatment and the last self-harm was 52 months (6 months to 7 years). No clients had hypertrophic marks or keloids. This research was carried out in accordance with the Declaration of Helsinki, and the research study procedure was examined as well as accepted by the Medical Research Study Ethics Board of Keio University (authorization number: 2012477-1). All individuals offered a composed educated approval before their addition in the research. The whole procedure was clearly explained before the treatment that marks could have not been entirely healed as well as they could be only improved to be less visible.

Personnel Treatment
After induction of general anesthetic and endotracheal intubation, antisepsis of the forearm skin was carried out with povidone– iodine, as well as the patient was draped under clean and sterile problems. The skin of the sterilized location was cut with an electric dermatome (Zimmer Biomet, Warsaw, Ind.) at a density of 250 μm. The accumulated skin was spread out on a plastic job plate, and the scar consisted of therein was excised utilizing a scalpel and sutured. The scar left externally from which the skin was collected was flattened with a pair of scissors. The harvested skin was implanted on the resurfaced wound at a 90-degree rotation perpendicular to the original scar.

The skin graft was dealt with onto the injury using a nonabsorbable nylon string. Given that the mark was cut and sutured, the skin graft was not enough to cover some parts of the wound. Therefore, the section of the skin graft that did not match the form of the injury surface area was excised and also made use of as a minced-skin graft. The little pieces of skin grafts (that were excess) were put on a plastic plate and also cut into pieces as tiny as possible (500 μm or less) utilizing two No. 22 scalpels. The minced skin with a mud-like look spread evenly over the resurfaced injury. Both the skin graft as well as the minced-skin graft were covered with a nonadhesive gauze, gauze as well as cotton were put thereon, and also fixed with a tie-over clothing. The surgical plan is shown in Figure 1. The treated arm or legs were taken care of with splints. The tie-over clothing was removed on postoperative day 4, and also succeeding dressings were altered every 3 days for 15 days.
A telephone study was carried out in May 2020, concerning 10 years after the procedure, to quantitatively examine the clients’ postoperative complete satisfaction. We explored the results of a 5-level assessment of their contentment relating to adjustments in the appearance of marks as a result of the procedure: 5, exceptional; 4, excellent; 3, standard; 2, below par; as well as 1, inadequate.

RESULTS
Revolved skin grafts and minced-skin grafts survived totally in all clients. Turned skin grafts were not nearly enough in 3 instances, as well as a minced-skin graft was utilized in mix. The postoperative observation period ranged from 6 to 24 months (typical duration was 13.5 months). Partial graft loss brought on by not enough addiction was observed in 1 individual; nonetheless, the injury re-epithelialized spontaneously. After implanting, from the recipient side, nodules appeared briefly due to hair extension from the staying hair follicles; however, they vanished in time. Although pigmentation and also redness around the skin graft took place in some cases, these similarly vanished gradually. No brand-new hypertrophic scar, keloid formation, or mark contracture occurred at any of the treatment websites. The pattern of DSH marks on the forearm was effectively transformed into a socially appropriate look (Fig. 2, 3). A few of the skin textures that were originally unnoticeable in the initial mark resembled normal skin. All clients were pleased with their look, as well as no new self-harm was observed in the 5 women throughout the follow-up duration. As a result of the telephone study carried out regarding one decade after the operation, all 5 individuals responded to the study, and the typical client contentment was 4.8 of 5.

-