Tratamento para cicatrizes tem sido cada vez mais ofertado por cirurgiões e não somente por dermatologistas. Não só pelo grande mercado que se pode conquistar, que vai além das cirurgias, mas também por gerar mais credibilidade ao médico, mais confiança e garantia de um paciente satisfeito. Mas não se deve esquecer que assim que o cirurgião retirar os pontos, a cicatriz passa a requerer cuidados.
A cirurgia de correção de cicatriz reduz a cicatriz de modo que fique mais uniforme com o seu tom de pele e a textura circundante. Muitas cicatrizes, inicialmente inestéticas, tornam-se aceitáveis após um período variável de três a 18 meses ou mais. Uma cicatriz aceita como agradável, estética ou normal, deve ser fina, sem relevo na pele, de coloração semelhante à da pele local e, às vezes, torna-se quase imperceptível. Mas existe um período de evolução onde a aparência da cicatriz sofre alterações físicas típicas de cada fase. As cicatrizes patológicas podem causar dor importante e/ou coceira tão intensa a ponto de interferir no convívio social da pessoa.
Melhorar o aspecto final de uma cicatriz é um desafio que interessa às diversas especialidades médicas, em especial à cirurgia plástica. A evolução natural de uma incisão cutânea resulta, na maioria dos casos, numa cicatriz linear e fina, mas sempre existe o risco de uma cicatriz hipertrófica ou da formação de um quelóide1,2. Apesar da evolução do conhecimento do processo de cicatrização, ainda não é possível realizar uma incisão cutânea sem deixar uma cicatriz, pois ela representa a consequência de todo ato cirúrgico. O cirurgião plástico deve, portanto, planejar a extensão e a localização da sua incisão, considerando a possibilidade de haver uma cicatriz de má qualidade. O resultado da grande maioria dos trabalhos aponta para melhora significativa na qualidade final das cicatrizes, de diferentes etiologias, após o uso de produtos à base de silicone gel3-8. É interessante notar, entretanto, que a totalidade dos trabalhos foi realizada em pacientes de pele clara.
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É fundamental este exame para que seja conferido as condições cardíacas para que não haja complicações durante a operação. Caso seja identificado algum problema, o paciente deve fazer uma avaliação com um cardiologista e informar o cirurgião plástico. Da mesma forma, o Risco Cirúrgico serve para estimar o risco do paciente durante a cirurgia.
O intuito da cirurgia é melhorar a aparência e uniformizar a pele, nem sempre garantindo o completo apagamento da cicatriz, e os resultados podem variar de acordo com a pele de cada pessoa. Para a realização do procedimento cirúrgico, o médico poderá solicitar alguns exames de sangue pré-operatórios. Como em qualquer cirurgia, é orientado o jejum de 8 horas, e o tipo de anestesia realizada depende do procedimento que será feito, podendo ser local, com uma sedação leve ou geral. Os resultados finais da cirurgia de correção de cicatriz podem levar vários meses para se tornarem aparentes e, em alguns casos, pode levar um ano para a nova cicatriz cicatrizar completamente. Cicatriz retrátil (ou cicatriz contrátil) é aquela que se apresenta tensa e repuxando, causando contratura entre os segmentos corporais envolvidos. Pode resultar de um ferimento que provoque a perda de uma área de pele, por intervenção cirúrgica , acidente ou queimadura , podendo assim formar uma cicatriz que traciona as margens da pele.
Esse seria o tipo ideal de cicatriz, já que indica que tudo deu certo no processo e que a fibra de colágeno voltou ao seu estado normal. Dentre os principais motivos para essa falta de oxigenação está o tabagismo. A exposição à fumaça reduz a hemoglobina funcional e o aporte de oxigênio para a ferida e dificulta a cicatrização.
O Que Ocorre Quando A Cicatrização É Lenta?
Use e abuse de alimentos que aceleram o processo de cicatrização e potencializam a imunidade, mas com orientação médica nutricional. Por fim, existe a cicatriz retrátil, que nada mais é do que um processo da pele sendo “repuxada” para dentro na região operada. Pode ocorrer ainda a formação de nódulos debaixo da pele, resultado do desenvolvimento de um tecido duro no local. As cicatrizes ruins ocorrem pelo excesso de colágeno na ruptura, fazendo com que ela fique elevada e, muitas vezes, deformada.
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“Após um corte, ocorre uma inflamação normal, que sinaliza para o corpo que está na hora de cicatrizar. Mas a situação complica quando existe um estado inflamatório preestabelecido”, esclarece. Durante a cicatrização é importante tomar alguns cuidados para que a cicatrização fique da mesma cor da pele, como evitar a luz solar e usar protetor a todo momento. Além disso, é importante garantir que a cicatrização esteja ocorrendo da melhor forma possível, sem interferências mastopexia recuperação e infecções. De responsabilidade do cirurgião plástico, os fatores referentes ao ato cirúrgico devem ser muito bem controlados, como técnica cirúrgica apurada, antissepsia, sangramento intra-operatório, tensão na cicatriz, entre outros. Este trabalho teve como interesse avaliar a evolução das cicatrizes em uma população miscigenada, usando um produto contendo silicone gel de rápida secagem, em cicatrizes exclusivamente resultantes de cirurgia plástica.
A área trabalhada sofre um processo inflamatório, atraindo linfa, e isso causa edema, falta de sensibilidade e dor. Com a drenagem, esse líquido é direcionado para a “saída”, ou seja, os vasos linfáticos, para ser eliminado pela urina. Por isso, mesmo que a cinta pareça um tanto incômoda, é preciso utilizá-la à risca, assim como a espuma , que evita a formação de dobras na pele.
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