Surgical scars

Wounds received during a surgical intervention heal with a scar on the skin and in the tissues under the skin. The scar is never equivalent to the destroyed tissues because its vascular bed and nerve functions are quite bad, it has no defence system and cannot tackle with mechanical stress. During our surgical interventions we immediately close the wounds left on the integument with a gentle technique, thus expectedly only a thin, soft, barely visible scar remains which affects neither the functions nor the look. The normal formation of scars can be influenced by many factors (age, skin type, part of the body, tension lines, pregnancy, hereditary factors, infection, allergic reactions, haematoma, physical-chemical irritation etc.). The formation of the scar can take a while and its maturation can last for a year during which it softens, whitens and becomes similar to its surroundings. During this period its surgical correction is advised only in special cases (burnt skin, ‘wrong direction’ scars). Certain people are susceptible to having their surgical wounds heal with a so-called pathological scar in spite of the most gentle surgical technique.

An atrophic scar has its corium missing from its thin, flattened base and frequently occurs when taking steroids, during pregnancy (stripes and striae are like this!) and with white skin types with a thin corium. The reason of its formation is the underproduction of colloid fibres within the scar, and as a consequence, the skin becomes vulnerable here and the scar very often widens.

A hyperatrophic scar bulges out from the skin and is often redder than its surroundings. Later its colour fades, the scar can flatten and can become atrophic during its maturation. It is frequent mainly during puberty, with young adults and on certain parts of the body (in the triangle between the shoulders and the sternum – cleavage). People with a thicker corium and a darker skin type are more susceptible to it. The same is true for a celoid as well, however, it bulges out from the scar to an extent that it spreads like candle-wax along its edges and will not regress. Patients often complain of itching and burning sensations on this area. To avoid celoids the surgeon has to make incisions in accordance with the tension lines of the skin and the tension of the muscles, use a tissue-friendly surgical technique and closure of the wound. In many cases the formation of celoids cannot be avoided even with these precautions and further treatments are needed because of the pathological scar.

Among the possible alternatives we can mention the surgical excision of the scar, then its tension-free merging with the stitches or adhesive tape and finally the soft x-ray irradiation (DERMOPAN) after the operation. Irradiation affects only the upper layers of the skin and does not enter the deeper tissues, thus it does not overburden the body. Within 6 hours after the operation it is recommended to be started and repeated 4 to 5 times 1 or 2 days later.

The chance of recurrence can be decreased with the use of silicone ointments or plasters which are advised to be left on the scar for months in accordance with the recommendations of the producers. Wearing compression clothes designed for various parts of the body can reduce the regeneration of the celoid. Ultrasonic and Soft laser irradiations are among the additional treatments. If a hyperatrophic scar or a celoid develop in spite of all our efforts, we can be forced to use a injection therapy (steroid and anaesthetic) which are recommended to be repeated in every 2 months if it proves to be successful.

What can you do for an optimal scar formation after the operation?

The most important thing is that you, following the instructions, should take care of the cleanness of the bandage, protect it from humidity (sweat, water), keep a peaceful lifestyle to minimize the tension of the scar. You have to appear at each control examination, and if at any time you notice a haemorrhage, a red spot, pain or fever, see your surgeon at once! The time of taking out the stitches does not correspond to the healing of the wound and the final formation of the scar, therefore it is very important to ease the scar (leuko strip plaster) and neglect sports for 1 or 2 months. Massaging the scar and treating it with antiphlogistic ointments (calendula, aloe vera) have beneficial results. The time of taking a shower is recommended to be discussed before the patient goes home since it can often precede the taking out of the stitches. After breast operations (silicone prosthesis, breast lift, breast reduction, oncological surgery) wearing a comfortable, yet flexible sports bra (top) night and day is advised for 3 months in order that the scars and the inner stitches can be eased and thus we can achieve the wished shape of the breasts and barely visible scars. Using cosmetics on the face is not recommended before and after an operation because every chemical material can influence the formation of scars.