Punch gratfs can be used for deep scars, such as ice-pick or deep box-car scars. A punch biopsy is used, which is like a cookie cutter tool that has varying diameters from 1.5 - 4mm. The size of the punch biopsy is matched to the size of the scar to include the walls of the scar. Following local anaesthesia, the scar is excised with the punch and the skin is sutured together. If it is noticeable following this procedure, the area can be treated by various resurfacing techniques.
Punch Excision with Skin Graft Replacement
With this approach the scar is excised with the punch biopsy instrument as above. Instead of suturing the skin edges together, a punch graft is usually taken from behind the ear and placed in the resulting punched out defect.
Alternatives
Once the scars have been marked out and anaesthetized, skin is taken from behind the ear (donor site) and is used to match the skin which is being excised. A device called a punch is used to excise the scars, and such punch devices have varying diameters. Usually the dermatologist uses a punch, 0.5mm or larger to remove the punch grafts from behind the ear. The grafts are then set into place. Steri-strips are applied and a dressing is placed over the grafts.
All skin types can be considered, although there is the possibility of hyperpigmentation occurring at the sites in darker skinned individuals. Treatment of choice for punched out scars 3 - 4mm in width, especially for deep "box car" and larger "ice pick" scars.
A smoother skin, with minimal downtime.
Safety and Side-Effects
There is the possibility of the punch graft either being too deep or too high on the skin.
Patients need to rest following the procedure to make sure that the grafts will take. Most patients will have their dressings removed after five days.
Does it Hurt?
Local anaesthesia is used to numb the scarred area, and a relaxing medication can be provided if necessary.
It is imperative that blood-thinners such as Aspirin and anti-inflammatory pills be avoided, as well as any naturopathic medications, two weeks prior to surgery. Alcohol should be avoided one day before surgery.
Continue to avoid blood-thinning medications. Return for review in five days. Minimize activity, and no strenuous exercise. No alcohol should be consumed for two days after surgery.
Dr McKerrow.