In most cases pathologic scars are managed using surgical procedures. In recent decades a trend towards the generalized use of flaps has been observed. Skin expanders have been applied for a while and are still useful in postburn alopecia. Large surfaces are being treated more and more with skin substitutes. These are mainly dermal substitutes covered with partial thickness skin grafts. These procedures can be combined in order to cover very large skin surfaces. Prefabricated flaps are based on angiogenesis induction via vessel carriers implanted in the depth of the skin structure. The use of skin substitutes limits skin harvesting, which may be a source of scarring.
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