Extensive Self-Harm Scarring: Successful Treatment With Simultaneous Use of a Single Layer Skin Substitute and Split-Thickness Skin Graft

Objective: Deliberate self-harm resulting in extensive skin scarring is a difficult clinical problem and is commonly associated with physical and sexual abuse or a known history of mental illness. Immediate hospital attendance often addresses the acute wound and current psychological state of patients; however, ongoing regret of these resulting scars present a problem to the patient and clinician. Deliberate self-harm to the skin leaves permanent and socially unacceptable scars in anatomically conspicuous areas and recognizable to others. Therefore, the aim was to offer a treatment to change these scars to that of an unknown entity. Methods: Six patients with extensive linear scars covering most of the forearm received surgical reconstruction. Patients were female aged between 18 and 47 years. Each patient had a history of psychosocial problems, and each had undergone psychiatric treatment. After an in-depth consultation and a further clinical psychological assessment, each individual was deemed suitable for reconstructive surgery. Scars were excised from the forearm en block, removing the majority of the affected area. Simultaneous use of a single layer skin substitute was used, covered by an autologous split-thickness skin graft. Negative pressure wound therapy was then applied immediately for 2 weeks after surgery. Results: The original scars were successfully converted to a socially and cosmetically acceptable appearance. Postoperative infection due to negative pressure wound therapy failure in one patient was the only complication reported. Conclusions: This case series highlights the utility of an innovative treatment for patients with DSH scarring resulting in aesthetic, psychological, and functional benefits.