July 2020 Procedure of the Month: Wound healing
Posted June 24, 2020
A common concern of patients that are considering a surgical procedure is the fear of scarring. Scars, or incisions, should be addressed during the initial consultation and any concerns or fears should be discussed at this time. Education is always key when it comes to discussing a potential surgery. Patients will need to play an active role in the healing process, this may pertain to self-care or dressings to the incision site. The consultation may also be a good time to review with the surgeon how scars may look so the patient will be comfortable as their body moves through the healing process.
Healing skin typically follows a very organized pattern for most people. However, genetics also plays a major role in the outcome of your scar results. Therefore, some people may be prone to keloids and thickened scarring (hypertrophic scars) due to their genetic predisposition and may not be aware of this until after surgery. Certain areas of the body heal better depending upon the density of the skin and amount of movement at the site. Different stages of life can also influence scarring depending on the hormonal influence occurring at the time of healing.
All humans heal with scar tissue. In most people, healing follows 3 distinct phases.
- The first is hemostasis. This happens immediately following the procedure and prevents post-op bleeding.
- The second is scarring. This process usually takes 6-8 weeks before completion. At the end of this period a scar may feel somewhat thick, tight, and may have funny sensations associated with the area. Sometimes patients have said they feel an “electrical shock” to the area or itching. At this time, the scar is immature but has repaired enough to prevent re-injury.
- The third phase is called remodeling. This phase typically lasts 10-12 months but can last up to a year and a half in some individuals. During this phase, the scar tissue matures, softens, flattens, and fades. The majority of this happens by 6 months postoperatively.
A common misconception regarding scars and how to enhance your recovery involves Vitamin E and scar creams. Unfortunately, creams do not penetrate the outer layer of the skin deep enough to have any effect on the scar itself. It is the massage used to apply the creams that will make the scar softer. Patients are often encouraged to massage a scar after the second phase of healing which occurs around weeks 6-8. Patients should not massage a scar until then or after they have been examined by their surgeon. Massaging too soon may be painful and the results ineffective until the scar goes into the remodeling phase.
Understanding the healing process can be an important part of your decision to have surgery. You should feel comfortable talking with your surgeon about the incision sites and the amount of time required for healing. Incision care should be addressed throughout your follow up visits and any concerns reviewed throughout the process.