James A. Rieger MD -Board Certified Plastic Surgeon -Wichita,Hutchinson,Salina,Newton,Garden City,Dodge City Kansas
316-652-9333


Scar Revision Informed Consent                                                            

This is an informed-consent document that has been prepared to help inform you concerning scar revision surgery(s), its risks, and alternative treatment. It is important that you read this information carefully and completely.  Please initial each page, indicating that you have read the page and sign the consent for surgery as proposed by your plastic surgeon.

INTRODUCTION

The surgical treatment of scars is a procedure frequently performed by plastic surgeons.  Scars are the unavoidable result of injuries, disease, or surgery.  It is impossible to totally remove the presence of a scar, yet plastic surgery may improve the appearance and texture of scars.  There are many different techniques of scar revision surgery.  Other treatments including physical or hand therapy may be needed in addition to surgery. There is no guarantee of any outcome. The goal is improvement not perfection. Satisfaction is based on realistic expectations.

ALTERNATIVE TREATMENTS

Alternative forms of treatment consist of not treating the scar condition, injections of cortisone type drugs into the scar, or the use of special compressive garments/devices worn over the scar.  Dermabrasion, laser treatments and other surgical techniques may be used to revise scars. Risks and potential complications are associated with alternative forms of treatment.

RISKS of SCAR REVISION SURGERY

Every surgical procedure involves a certain amount of risk, and it is important that you understand the risks involved.  An individual’s choice to undergo a surgical procedure is based on the comparison of the risk to potential benefit.  Although the majority of patients do not experience these complications, you should discuss each of them with your plastic surgeon to make sure you understand the risks, potential complications, and consequences of the surgical revision of scars. 

Bleeding- It is possible, though unusual, to experience a bleeding episode during or after surgery.  Should post-operative bleeding occur, it may require emergency treatment to drain accumulated blood (hematoma). Do not take any aspirin or anti-inflammatory medications for 2 weeks before and 2 weeks after surgery, as this may contribute to a greater risk of bleeding.  Non-prescription “herbs” and dietary supplements can increase the risk of surgical bleeding.

Infection- Infection is unusual after surgery.  Should an infection occur, additional treatment including antibiotics or additional surgery may be necessary.

Scarring- All surgery leaves scars, some more visible than others.  Although good wound healing after a surgical procedure is expected, abnormal scars may occur both within the skin and the deeper tissues.  Scars may be unattractive and of different color than the surrounding skin.  Sutures and staples used to close the wound may leave visible marks.  There is the possibility that scars may limit motion and function.  Additional treatments including surgery may be needed to treat abnormal scarring.

Damage to deeper structures- Deeper structures such as nerves, blood vessels and muscles may be damaged during the course of surgery.  The potential for this to occur varies according to where on the body surgery is being performed.  Injury to deeper structures may be temporary or permanent.

Wound disruption- Until wound healing is complete, it is possible to split open the surgical wound where the scar revision was performed.  Wound disruption can produce a poor surgical result.  If this occurs, additional treatment may be necessary.

Deeper sutures- Some surgical techniques use deep sutures.  These items may be noticed by the patient following surgery.  Sutures may spontaneously poke through the skin, be visible, or produce irritation that requires removal

Patient compliance- Patient compliance with post-operative activity restriction is critical.  Personal and vocational activities that involve the potential for re-injury to the scar revision must be avoided until healing is completed.

Allergic reactions- In rare cases, local allergies to tape, suture material, or topical preparations have been reported.  Systemic reactions which are more serious may result from drugs used during surgery and prescription medicines.  Allergic reactions may require additional treatment.

Surgical anesthesia- Both local and general anesthesia involve risk.  There is the possibility of complications, injury, and even death from all forms of surgical anesthesia or sedation.

Delayed healing- Wound disruption or delayed wound healing is possible.  Some areas of the skin may not heal normally and may take a long time to heal.  It is even possible to have loss of skin or deeper tissue.  This may require frequent dressing changes or further surgery to remove the non-healed tissue. Smokers have a greater risk of skin loss and wound healing complications.

Unsatisfactory result- There is the possibility of an unsatisfactory result from the surgery to revise scars.  Surgery may result in unacceptable visible deformities, loss of function, wound disruption, skin death and loss of sensation. You may be disappointed with the results of surgery.

ADDITIONAL SURGERY NECESSARY

In some situations, it may not be possible to achieve optimal revision of scarring with a single surgical procedure.  Multiple procedures may be necessary.  Should complications occur, additional surgery or other treatments may be necessary.  Even though risks and complications occur infrequently, the risks cited are the ones that are particularly associated with scar revision surgery.  Other complications and risks can occur but are even more uncommon.  The practice of medicine and surgery is not an exact science.  Although good results are expected, there cannot be any guarantee or warranty expressed or implied on the results that may be obtained.

FINANCIAL RESPONSIBILITIES

The cost of surgery involves several charges for the services provided. This cost includes: surgeon’s fee, anesthesia fee, surgical center fee, office visits, and if applicable initial garment, implants, and overnight stay at the surgery center.  Prescription medications and any pathology are a separate expense and are not included in this quote. All costs arising directly or indirectly from surgery such as post surgical recovery longer than expected, inpatient hospitalization, complications, emergencies, transportation, ambulance, medical flights and  blood transfusion, if needed, are not included in these costs.  These and any other unanticipated fees and costs, including those not covered by insurance, are the responsibility of the patient.

If the procedures do not meet the patient’s highest expectations, and revision procedures are desired to achieve better results within the first two years, there may be, on a case by case basis, a reduction in the surgeon’s fee for the revision procedures.  However, the cost of the operating room, hospital, supplies, implants and anesthesia will be the responsibility of the patient.

DISCLAIMER

Informed-consent documents are used to communicate information about the proposed surgical treatment of a disease or condition along with disclosure of risks and alternative forms of treatment(s).  The informed-consent process attempts to define principles of risk disclosure that should generally meet the needs of most patients in most circumstances. 

However, informed consent documents should not be considered all inclusive in defining other methods of care and risks encountered.  Your plastic surgeon may provide you with additional or different information which is based on all the facts in your particular case and the state of medical knowledge.

Informed-consent documents are not intended to define or serve as the standard of medical care.  Standards of medical care are determined on the basis of all of the facts involved in an individual case and are subject to change as scientific knowledge and technology advance and as practice patterns evolve.

It is important that you read the above information carefully and have all of your questions answered before signing the consent .

 

                I have received, read and understand the following Informed Consent Material for my specific procedure:

Informed Consent For Scar Revision

Medication and Smoking Avoidance Sheet

DVT prevention sheet

 

The risks, benefits, and alternatives of the procedure(s) were explained to me. I understand the specific risks in the consent material for my surgery and understand the significant risks of return of the scar and possibly with a more undesirable scar, bleeding, infection, injury to neighboring structures, capsule contracture(if implants involved), asymmetry, excess skin requiring future revision, contour skin irregularities, pulmonary emboli, deformity, healing problems, poor scars, loss of sensation(feeling), appearance/psychological  changes, unsatisfactory result, need for future revision surgery and anesthesia. I understand the anticipated results and limitations of the surgery procedure(s). I have realistic expectations and realize that there are no guarantees in plastic surgery. The following instructions were explained to me: Pre and Post procedure instructions, DVT prevention instructions, and medications to avoid instructions. I agree to follow all instructions, to follow up as directed, and to notify the office if any problems or questions arise.

 

 

Sign →                             

 

                                                                                  

Witness →