Usefulness of Local Flaps for Scar Contracture Release

Local flaps are useful for reconstructing scar contractures on mobile areas such as joints, the neck, the axilla, the digital web, and the mouth commissure. They are superior to skin grafts because the latter can contract, thereby leading to secondary contractures. Moreover, the color and texture match of local flaps is better than that of grafted skin. Consequently, local flaps generally provide superior aesthetic outcomes. Thus, if there is healthy skin adjacent to the scar contracture, local flaps should be the first choice. In terms of local flap selection, it is necessary to choose between a skin-pedicled flap and an island flap. We showed recently that 6 months after surgery, skin-pedicled flaps associate with greater scar extension rates than island flaps. Thus, local flaps, especially skin-pedicled flaps, elongate the scar as effectively as z-plasty. It should be noted that if the scar is large, it is effective only by dividing the scar with the local flap. However, the flap size can be slightly smaller than the deformity size (although how much smaller depends somewhat on how extensible the flap type is): it is not necessary that the flap is as big as the open wound after scar division or scar removal.