Preventing scarring post surgery:
If you have surgery, you will get scars? Well, yes and no. It is inevitable that by making an incision in your skin, that the body will try to repair the ‘damage’. How your body is allowed to heal is the key to preventing ‘bad scarring’. There are some un-modifiable reasons for poor wound healing such as age, gender, ethnicity or a history of keloid or hypertrophic scarring. However, there are many risk factors for scars that can be optimized to promote the optimal result in wound healing.
There are two main components to wound healing, the perioperative period and the postoperative period.
The perioperative period relies on your surgeon to optimize your wound healing throughout the operative process. The key to getting the best possible outcome for your cosmetic appearance is to reduce wound tension. This starts with the surgeon discussing with you and selecting the correct area and orientation to make the incision.
· Sometimes just by moving the scar by 1-2cm can make the difference between being able to hide the scar under clothes, and having it on display at all times.
· There are specific lines on the human body known as Langers lines or relaxed skin tension lines, that are known for having the least tension. Most surgical incisions should follow these lines. The wrong selection of surgical incision is one of the biggest factors in developing hypertrophic scars.
· Exact surgical technique, including careful tissue handling, prevention of infection, stopping excessive bleeding and accurate approximation of tissues allows the best possible environment for good wound healing.
· Using the correct stitch material with the correct technique, allows the skin to start remodeling correctly. It is important to remember that it is the components of your tissue itself that promotes good healing, the stitches just allow this to happen!
The postoperative period is the time after the operation, when you are more in control of improving your cosmetic outcome.
· Breathable dressings allow optimal wound hydration in the first few days
· Skin glues allow a waterproof barrier to reduce skin infections
· Wounds can be cleaned with water, but detergents/alcohol/iodine based products should be avoided.
· Any non-absorbable sutures should be removed after 7-10 days and can replaced by skin tapes or silicon gels.
· Skin tapes are widely available, and should be used to take the tension off your wound. These can be used for 3-6 months until your skin has recovered most of its elastic potential
· Silicon sheets can be used as an alternative, and have been shown to be particularly effective in large wounds such as caesarian section scars.
· ‘Scar reduction oils’ such as Bio-oils have often been used. There doesn’t appear to be robust scientific evidence that they work to reduce scar formation, however anecdotally they can be effective, and certainly do not have any detrimental effects on healing.
As a patient myself who suffers from hypertrophic scars, I completely understand the anxiety associated with developing scars on obvious parts of your body. As your surgeon, I will guide you through the process of surgery, using evidence based surgical techniques to minimize wound tension to promote the best possible wound healing. I will also advise thoroughly about postoperative care and wound management, to ensure that you are happy with your cosmetic results!
