الفهرس 
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Abstract
Wound healing, or wound repair, is an intricate process in which the skin or another organ repairs itself after injury. Wound healing is evolutionarily optimized for speed of healing, where compensating, rapid inflammatory response with overlapping cytokines and inflammatory cascades allows the wound to heal quickly to prevent infection and future wound breakdown. A scar may therefore the price we pay for evolutionary survival after wounding.
Up to half of patients living with disfiguring conditions suffer concerning levels of anxiety, social avoidance and quality of life (QoL) especially in scars often include areas important for social interaction such as the hands or face.
Current management of scars encompasses a wide range of techniques, from traditional invasive methods such as gross excision and radiation to intralesional and topical application of agents designed to take effect on a cellular level.
The proper classification of a scar is imperative before any treatment is initiated. scarring can be divided into 5 basic types: Atrophic Scars, hypertrophic Scars, keloids, striae distensae and pigmented Scars.
The new successful combination therapy in treatment of atrophic acne scars and other depressed scars is subcision-suction method. Subcision is a term coined by Orentreich and Orentreich in 1995 to describe the minor surgical procedure for treating depressed scars and wrinkles. The principle of this procedure is to break the fibrotic strands by a tri-beveled hypodermic needle, which tether the scar to the underlying subcutaneous tissue. The depression is lifted by the releasing action of the procedure, as well as from connective tissue that forms during the course of normal wound healing.
Although subcision is safe, valuable and practical, depression recurrence is a very common side effect and overall improvement is mild to moderate. Some authors hypothesized that repeated suctioning (or vacuum) of the subcised scars at the recurrence period might prevent redepression by prevention the reattatchment and more new connective tissue formation at the scar area.
The aim of this study was to evaluate the subcision –suction method in treatment of depressed scars (post acne scars, chickenpox scars and post-traumatic scars).
In this study, the 20 patients were treated by subcision-suction method and were classified according to regularity of suction sessions to group A1, group A2 and group B.
Group A1 included 11 patients (55%) who were started suctioning from 3rd day after subcision daily in the first week and continued it every other day in seconed week of suction period.
Group A2 included 5 patients (25%) who were started suctioning from 3rd day after subcision every other day for 2 weeks of suction period.
Group B included 4 patients (20%) who were started suctioning late (5th–7th day after subcision) and ⁄ or had long intervals between sessions.
Two investigators and the patients rated improvement of scars using percentage after completion of treatment in the stage of 2 to 6 months. To assess the improvement, close visualization including comparison with preoperative photographs and clinical data were used. Scar elevation, decrease in size and smoother appearance of scars were attention points. Finally, the minimum rate on which both investigators agreed was considered as investigators’ view in the study.
The results of this study were as follows:
There was improvement in scars in all groups after the treatment among investigators’ and patients’ view. All groups showed improvement in scars (groupA1 > group A2 > group B) after the treatment. There was highly significant correlation between suction sessions regularity on subcised scars and mean improvement of scars regarding investigators’ and patients’ view (P value =0.001).
In this study, There was no statistically significant difference between type of scars and mean improvement of scars regarding investigators’ view or patients’ view. The improvement percent among patients (>18) years is higher than that among patients (≤18) regarding investigators’ and patients’ view. There was statistically significant correlation between age and mean improvement of scars.
The improvement percent among female is higher than that among male regarding investigators’ view, while it’s higher among male regarding patients’ view. The mean improvement is slightly higher among male. There was no statistically significant correlation between patients’ sex and mean improvement of scars regarding investigators’ view (P value =0.77) or regarding patients’ view (P value =0.76).
As regards side effects occurred in patients included in this study, pain at the time of subcision in some cases, transient hemosedrosis, haemorrhagic papule, pustule, post operative swelling, bruising and tenderness and firm bumps at treatment sites. Post operative swelling, bruising, tenderness and firm bumps at treatment sites were occurred in all the 20 patients. All of these complications were transient.
There was insignificant effect of complications incidence on the mean improvement of scars regarding investigators’ view (P value =0.94) or regarding patients’ view (P value =0.72 NS).
Conclusion
Finaly, this method is well tolerated with local infiltration of anesthetic, it is a simple technique, and it deserves to be a first line treatment for many moderate atrophic scars due to absence of any epidermal injury except for minute needle insertion points, long lasting scar correction and reasonably persistent correction of wrinkles. Furthermore, subcision is not associated with the risk of allergic reactions and the materials required to perform are readily available and inexpensive.
At the end the treatment by Subcision-suction method, all groups showed improvement after the treatment. But results showed highly significant correlation between the suction sessions regularity and the improvement of scar.