Broken-Line Template for Revision of Facial Scars
01 December 2017 (online)
Revision of facial scars presents a significant challenge to plastic and reconstructive surgeons. In 1969, Webster introduced the geometric broken line closure (GBLC) technique for scar revision. The scar is excised in such a fashion that a series of randomly alternating triangle, rectangle, trapezoid, semicircle, and square flaps are cut on one side of the scar. The same contour is cut on the other side. The wound edges come together with geometric flaps interdigitated. It is complex and time consuming to plan and perform GBLC. To obviate the “sophisticated nature” of GBLC, we developed a flexible broken-line template for revision of facial scars to make the technique quicker, easier, and more effective.
The silicone template is 1 mm in thickness and 10 mm in width. The length of the template ranges from 5 to 12 cm. One edge consists of a series of randomly alternating rectangle, triangle, trapezoid, and square patterns. The limbs of the segments are limited to 3 to 6 mm in length ([Fig. 1]). Flaps larger than 6 mm result in scars easily noticeable to naked eyes and therefore insufficiently camouflage. Flaps less than 3 mm may lead to too many flaps. The template is filmy and flexible; so, it may be easily bent forward or backward. When the scar axis is curved, the template can be bent to match the alignment of the scar. Template orientation tends to be parallel to the scar, and the sawtooth side is placed toward the scar. The template should be positioned as closely to the scar as possible. Removal of scar tissue should be achieved while minimizing the total amount of tissue loss to help decrease the tension when the incision is closed. After one side margin of the excision is outlined, the start and end points are marked on the template. The template is advanced to the other side of the scar to mark out the complementary margin. The whole scar should then be sandwiched between two uniform geometric broken lines. The lines should be terminated with an angle of no more than 30 degrees ([Fig. 2]).
Our modified technique has many advantages. First, one silicone template can be sterilized for use in multiple cases. The slim silicone template is flexible. The template can be bent to be parallel to the long axis of line scar whether it is straight, curved, or tortuous. Second, by tracing out the contour of a series of flaps on the template, the two incision lines on both sides of scar are marked alike. We do not need to deal with odd skin flaps due to design error. The concaves and convexes match accurately with each other and there is no redundant skin to trim. Finally, relying on accurate design, our modified technique significantly reduces the time of planning, designing, and executing.