Small-Wave Incision Method for Linear Hypertrophic Scar Reconstruction: A Parallel-Group Randomized Controlled Study

The usual hypertrophic scar reconstruction methods such as Z- and W-plasties can leave noticeable scars and involve excessive normal skin excision, particularly in long linear hypertrophic scars longer than 10 cm. Thus, we invented and applied the small-wave incision method for patients with linear hypertrophic scars. A total of 40 patients with linear hypertrophic scars were included in this study. The patients were randomly assigned to the linear incision group (n = 20) or the small-wave incision group (n = 20). All scars were mildly hypertrophic, longer than 10 cm, and located in the lower abdominal/suprapubic region. They occurred after Cesarean section or gynecological or abdominal surgery. Patient age and sex, the cause of the scar, and the preoperative and postoperative sizes of the scar were recorded. Postoperative scar size and recurrence were evaluated for 18 months. Mathematical comparisons were also made to multiple linear incision, Z-plasty, planimetric Z-plasty, and W-plasty. Postoperative recurrence was 40 and 15% in linear and small-wave groups, respectively (P = 0.77). The main risk factor for recurrence was postoperative size (P = 0.043). Mathematical comparisons revealed that the small-wave method can achieve the same release of tension with the least normal skin excision while making the scar irregular via an accordion effect. The small-wave method can meet both the functional and the cosmetic requirements of long linear hypertrophic scar reconstruction while reducing complication risks.