For a successful scar treatment, a carefully developed concept, and a corresponding treatment plan are required to restore both functionality and aesthetics of the affected region. When conservative treatment fails, surgical measures offer a wide range of options for rehabilitation, including excision and Z-plastic, as well as local and regional flaps. In cases of severe scarring, and if the tissue is severely damaged, radical excision and reconstruction by means of a free flap may be necessary. In this case, an individual therapy concept must be defined. The consequences of severe scarring can lead to functional deficits, or even loss of function of the affected areas.