Scar Management After Surgery

All surgery produces scars. Good scar management involves planning the type of incision (cut) to be made, achieving tension free wounds, delicate tissue handling, appropriate suture techniques and adequate post-operative care, including rest of the affected part.

Early removal of skin sutures, 3 to 5 days on the face and 7days for most other areas, is essential and can be done with safety as most of these wounds have a buried layer of sutures in the dermis (deeper part of skin) which dissolve in about 6 to 8 weeks.

3 to 4 weeks after suture removal, the patient is started on scar management techniques.

Low pressure constant compression for at least 3 months appears to give the best results. This can be intermittent scar massaging, a paper tape or silastic gel or a compression garment. The improvement is probably caused by the compression as well as preservation of moisture in the scar.

Wound Healing after surgery is measured as “tensile strength” (the force needed to tear apart the wound) and 50% of this recovery of strength occurs in the first 3 weeks.
A further 20% occurs in the next 3 weeks and a final 15% in the last 6 weeks.
For patients recovering from surgery, especially major surgery, a “rule of thumb” on postoperative care and restrictions would be:

  • First 3 weeks – get everybody else to look after you

  • Second 3 weeks – look after only yourself

  • Last 6 weeks – normal activity but no sports or exercise gentle walking allowed

During this first 3 months, compression garments, where appropriate are to be used by the end of the 1st week.
Other methods of scar management, including intermittent massaging or constant compression with paper tape or silastic gel, is started at 3 to 4 weeks.

The Management of Abnormal Healing

There is a significant risk of abnormal healing, either hypertrophic or keloidal, after injury and surgery.
This could be due to poor scar management or other intrinsic factors, such as the position of the scar or the ethnicity of the patient.
If the problem is mild and localised, limited use of intralesional steroids (Kenacort) injections can be sufficient.
Alternatively, some form of compression therapy could be tried, to see if any improvement is possible.
In a percentage of patients, the only improvement possible is by excision (removal) of the scar and starting all over again.
While this seems a reasonable approach, the danger is the possibility of a recurrence and to avoid this, post-operative compression therapy is a must and all preparations need to be in place before surgery.
A common problem is post earlobe piercing keloids. Before surgery, a suitable pair of earrings has to be made to measure, to permit usage after 2 or 3 weeks after the surgery.
If a compression garment has to be used, it is available before surgery.
In difficult situations such as over a joint, where a compression garment and immobilisation would be required, a pre-operative trial is given for about 2 weeks, to give the patient a chance to see if the required garment and immobilisation is acceptable.

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