Accidents happen – but when might a child need plastic surgery for scar therapy?
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Accidents happen – but when might a child need plastic surgery for scar therapy?
KK Women's and Children's Hospital sees 60 to seventy cases that need stitches a week, by and large caused past children falling down or colliding with other kids. Here's how to know if a trip to the GP will suffice.
(Photo: Unsplash/Clark Young)
27 Nov 2022 06:30AM (Updated: 13 Aug 2022 01:13AM)
Getting cuts and scrapes is all part of growing upward. And even when Junior'due south bawling his eyes out, information technology usually merely takes some DIY cleaning, antiseptic cream, bandages and a kiss from Mummy to sort things out. Unless it'due south a bit more than serious.
What counts as serious? Co-ordinate to Dr Melissa Tan, senior consultant at National Skin Center, any wound that is deep and is haemorrhage profusely, in a critical area such as the eyelid, and/or is accompanied with fever and signs of infection warrants a doctor'south assessment.
"The most common causes of lacerations include children falling down and hitting hard objects, or colliding with other children," said Dr Gale Lim, head and consultant from KK Women's and Children'southward Hospital'southward (KKH) Section of Plastic, Reconstructive and Aesthetic Surgery, which sees an average of 60 to 70 cases that require stitches each week.
Some parents have already gone further than the GP or A&E section by involving plastic surgeons. Dr Andrew Khoo, a plastic surgeon at Mount Elizabeth Hospital's Aesthetic & Reconstructive Centre, tends to ane or two cases a week – commonly on the face and "especially in complex areas like the eyelids, near the lips, nose, ear and effectually pilus-bearing areas like the eyebrows". "All these structures have multiple layers and have visible junctions which require accurate alignment of the tissue," he said.
Special techniques such as subcuticular stitching, which hibernate the stitches under the skin and exit fewer sew marks, are used.
Although experienced A&E doctors are also able to "stitch equally nicely as any plastic surgeon", the latter "perform surgery on the face up routinely and so, would be more familiar with the layers and structures of the confront," said Dr Khoo of the departure. And if a scar becomes hypertrophic (that is, the wound produces excessive tissue as it heals but not to the extent of forming a keloid), plastic surgeons can human activity early with steroid injections during the follow-upward menstruum, he said.
IS In that location A MINIMUM AGE FOR PLASTIC SURGERY?
There isn't ane, according to Dr Khoo. But "if general anesthesia is involved, so the anaesthesiologist will assess if the child is onetime plenty and fit for anaesthesia," he said.
WHEN SHOULD YOU Accept YOUR KID TO A PLASTIC SURGEON?
It would be very plush – not to mention, an ineffective utilise of medical services – if parents rush to a plastic surgeon at the first sign of blood. "The first line of contact is unremarkably a doctor from the A&E department," said Dr Khoo. They can also propose if a plastic surgeon is required.
Generally, an injury that extends into the dermis (the middle layer of the pare) or across will unremarkably get out a scar, said Dr Tan. "Stitches are required to close the wound and appose the peel should a laceration extend into the subcutaneous tissue (fatty layer deeper than the dermis)."
HOW SOON AFTER AN Accident SHOULD ONE GET PLASTIC SURGERY?
"If plastic surgery is decided, it is all-time to manage it right from the start," said Dr Lim. "The patient can seek further assessment with a plastic surgeon on the twenty-four hour period the trauma occurred. If the wound heals with a less-than-ideal scar, parents can likewise seek advice from a plastic surgeon after, with a view to improve the scar or go for scar therapy."
According to her, the outcome of plastic surgery on a mature scar (whitish instead of a pinkish appearance) is similar to a fresh one, and is non dependent on when the plastic surgery is performed or even the kid's historic period.
The patient can seek further cess with a plastic surgeon on the 24-hour interval the trauma occurred. If the wound heals with a less-than-ideal scar, parents can too seek advice from a plastic surgeon afterwards on, with a view to amend the scar or go for scar therapy.
But the risk of scarring may be higher if the wound is complex, said Dr Khoo, referring to tissue loss or jagged edges as hypertrophic and keloid scars may form in the long term.
To handle that, Dr Lim said that "meticulous surgical technique followed past early silicone gel therapy can optimise the consequence of scars".
WHAT IS DONE DURING PLASTIC SURGERY?
Dr Lim explained: "To ensure the best possible scar outcome, the wound will exist cleaned and surgically debrided (damaged tissues or foreign objects removed) before the wound is closed in layers. In an older wound, we would still do the same".
DON'T STITCHES CREATE SCARS?
Aye, the stitching itself tin can cause scarring, said Dr Khoo, "only nosotros minimise this by using very fine stitches" during plastic surgery. Sometimes, special techniques such as subcuticular stitching, which hide the stitches under the skin and go out fewer sew marks, are used, he said.
Still, the majority of scars is caused by the injury itself, said Dr Khoo. "When we care for an injury, we look at how deep the injury is, and what the best way of treating the wound is. If the wound is a shallow abrasion, it is best not to stitch it up. If it is a deep laceration, we would prefer to sew together it upwards as it is likely to requite a much nicer scar than leaving it lonely to heal."
Information technology is likewise about "how many layers of the skin take been cut and where the cuts are," said Dr Khoo. "For example, on the eyelid, even a shallow laceration tin involve many layers. Stitching of the wound would exist advised in this example. A shallow abrasion in the knee could be immune to heal on its own."
In general, minimal scarring "starts with the initial treatment of the wound", he said. Then, it's down to "conscientious stitching with practiced alignment and tissue handling". Side by side, information technology'due south about suture removal at the right fourth dimension, and the use of scar creams and gels.
READ: Should you be worried most your kid's sweaty hands and feet?
WHEN Exercise THE STITCHES Come up OFF?
Dr Lim explained that "typically, stitches on the face up will exist removed afterwards one calendar week. Stitches on the body and limbs are removed in virtually ten days and fourteen days respectively. Stitches on the scalp and ears are removed in ten days".
The timing is crucial considering "if the sutures are removed too early on, the wound might open upwardly and create a poor scar", said Dr Khoo, explaining that if the stitches are left on for too long, the sew marks may create a train track-like appearance.
"We always inspect the wound before nosotros remove the stitches to make sure that the wound is healed. Information technology is not uncommon for the charge per unit of healing to vary from person to person," he said.
READ: How to get relief for children with migraine headaches
WHAT IS THE Price INVOLVED?
The medical bill is dependent on "various factors, including the nature of the injury and the complexity of the surgery," said KKH'due south spokesperson, explaining their inability to provide a ballpark figure for the cost of plastic surgery for children.
Another big contributor to cost is whether general amazement is used. "Very immature children need special equipment and special monitoring for general anaesthesia and this adds to the cost," said Dr Khoo. "Anaesthesiologists generally regard children younger than xviii months old as special cases."
If local anaesthesia is used, the total bill from a individual infirmary can range from S$2,000 to S$iv,000; and S$seven,000 to S$12,000 if general anaesthesia is used, said Dr Khoo.
Source: https://cnalifestyle.channelnewsasia.com/wellness/plastic-surgery-children-accident-234286
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