Surgical Scar Revision with A-Plasty

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We read with great interest the article from Khansa et al. entitled “Evidence-Based Scar Management: How to Improve Results with Technique and Technology.”1 The authors performed a literature review of high-level studies analyzing methods to prevent or improve hypertrophic scars, keloids, and striae distensae.
They conclude that, for the treatment of existing hypertrophic scars, silicone, pulsed-dye laser, carbon dioxide laser, corticosteroids, 5-fluorouracil, bleomycin, and scar massage have high efficacy, whereas onion extract and fat grafting seem to have low efficacy. For keloid scars, effective adjuncts to excision include corticosteroids, mitomycin C, bleomycin, and radiation therapy.
The appearance and symptoms of established hypertrophic scars may be improved with injection of substances that cause scar atrophy, pulsed-dye laser treatment, pressure garments, and scar massage. We can choose nonsurgical treatment or surgical treatment to achieve the purpose of repair and reconstruction of scar contracture deformity after considering the factors of function and appearance.2
In our opinion, surgical treatment should be taken into consideration by the plastic surgeon. In general, surgical revision of scars should be delayed for at least 12 months.3
The various surgical techniques of revising the scar are as follows: fusiform elliptical excision, Z-plasty, S-plasty, W-plasty, geometric broken-line closure, and V-Y and Y-V advancement techniques.4 The plastic surgeon should be experienced with each of the surgical revision technique and apply these methods as appropriate.5
With this letter, we propose our personal surgical technique (the A-plasty) to revise the scar, in alternative to the previously described techniques, with a different drawing (Fig. 1). The initial drawing represents “A” along the excision line; subsequently, the A is deprived of its triangular component, and only the design of trapezoids along the excision line is kept. We commonly perform the A-plasty in scar revision. Among the reasons why it is useful in scar revision is its ability to make the revised scar not lie in or parallel to a crease line or relaxed skin tension line, as opposed to a W-plasty or Z-plasty.
The A-plasty could be an excellent alternative, to avoid a zig-zag incision, especially in delicate anatomical areas, such as the face (Fig. 2). The technique is very easy to execute and can be used in both web and linear contractures. It offers a new option for the correction of linear scar contracture that is safe, simple, and effective. As with any technique, careful preoperative planning and meticulous execution lead to great results.
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