Scars from trauma
If you watch the interview I did with Campbell Live (Click on “in the media” at the top of the page and scroll), you’ll have some idea of the added complications that we face when dealing with wounds that result from trauma.
Before we reach the stage of being able to think about reconstructing them we have to contend with dirt and bacterial contamination; traumatic tattooing with grit and asphalt; variable thickness and surface area of damage and variably crushed and revitalised skin and soft tissues.
It is only once we have addressed those thoroughly (which sometimes means pausing with just a dressing on a wound and returning to theatre a day or two later to re-examine a wound under anaesthetic and do anything further that reveals itself) that we can address reconstructing a wound.
The other difference between how surgical scars and traumatic scars are revised is that traumatic scar revision usually requires several stages, each with a delay of 6-12 months between them as the tissues are allowed to settle and heal and relax.
Balancing these conflicting factors and dealing with this degree of complexity is why the surgeon reconstructing a traumatic wound must have the full reconstructive toolbox available to them.