ANSWER:
Hello,

I did a similar sort of surgery for a military patient once, before I retired. He had a very large brown mole on his back, over his right shoulder-blade, which I first removed and then stitched up the hole.

He came back saying that it had healed up fine, but the skin felt so tightened up now, that he couldn’t raise his right arm properly.

The problem was to find some looseness for him.

I cut two large “Z- plasty” flaps in his LEFT lower-mid back, and transposed the flaps. This pulled in extra skin from his upper-left back and from his lower back, and so gave him the looseness he needed. It worked well except that he then had a z- shaped scar, which did fade.

Your problem is similar, except that it sounds like your scar-line first expanded into an oval, and then into an indented circle, consisting of thin skin, – covering over a layer of red scar tissue underneath?

In my humble opinion your fundamental problem is that you have completely lost a largish piece of skin, and the hole which that created has basically filled in with scar tissue.

There wasn’t enough stretch in your skin, so your scar itself had to stretch. It’s the underlying scar-tissue there, that is now giving your scar this purple colour.

There are only two surgical options I can think of. The first is to get a Z- plasty done, much as I have described. The second (much worse) is to have a full-thickness skin graft, either a Wolff graft or a re-vascularised free graft.

Neither of these would be perfect cosmetically. I did my procedure above mostly for the recovery of arm function; appearances weren’t quite so important. You would be exchanging your present sunken scar either for a flat Z shaped scar, or alternatively for a scar somewhere else on your body where your donor skin-graft came from, – and also for a further split-skin donor site to cover that.

I appreciate that I’ve been using a lot of medical jargon. I rather despair of explaining without the aid of diagrams, how a Z- plasty works. What essentially is happening is that you are pulling together loose skin from 2 opposite directions, both in towards some centre line, – and then using that looseness to lengthen out the chosen centre-line, by about 75%.

The centre-line is chosen to be in the direction you need the loosening.

If you don’t do anything, I think the purple colour may continue to fade, although this is usually for only up to 18 months after the operation. But the indentation will never fill in. I suppose you could have a collagen filler injection, like women have to bulk up their breasts.

I hope this is of some help. Honoured to be able to assist a fellow Top Contributor.

Ideally some skin-relaxation procedure should have been done *at the same time* as your big removal operation, perhaps a Z- or a V-Y plasty , – but your Dermatologist conceivably did not have enough parallel expertise in the specialty of plastic surgery, bless her heart.

She did exactly right to remove this dangerous mole with a large amount of clearance, – in case the mole had been cancerous. But she then perhaps closed too large a hole with simple stitching, when there wasn’t enough stretch and “give” in the two opposing sides. As I did. You too may have felt tightness at the time.

Best wishes,

Belliger
retired uk gp