It is inevitable that surgical scars will remain after surgery. The choice of surgical incision will affect the surgical result and also affect the shape, size and depth of the surgical scar, so choosing the right surgical incision during surgery is still a good foundation for eliminating the surgical scar in the future.
Causes of surgical scar formation
1. Skin tension, including the external tension caused by the degree of skin tissue deficiency and the inherent tension of the skin tissue itself. The areas with high tension and lots of activities are prone to hyperplastic scars, such as the lower jaw, anterior sternum, deltoid, upper back, elbow, hip, knee, ankle, and dorsum of foot.
2.Age (young people are prone to hyperplastic scars, especially the highest rate of hyperplastic scars occurring at the age of 10-20 years old, mainly due to the vigorous growth of tissues during youth development, strong post-traumatic reactions, and high skin tension);
3, skin pigmentation (people of color have more pigment cells and are also susceptible to stress reactions; the incidence of scars in blacks is 9 times higher than that in whites; they are likely to occur during periods of pituitary physiological activity such as puberty and pregnancy);
4, infection (repeated infection, long-term trauma exposure, excessive proliferation of granulation tissue, prone to hyperplastic scars or scars);
5.Foreign bodies falling into the wound (dust, talcum powder, fibers and residues of hair follicles, sebaceous glands and sweat glands can cause tissue reaction and lead to scar hyperplasia);
6, other factors (the angle between the incision and the skin, the incision perpendicular to the skin, the thinnest scar after healing; the greater the angle of inclination, the wider the scar of the dermis, the more obvious the skin deformity. There is also the depth of the trauma and the healing time of the trauma).
Surgical incisions affect surgical scars
The choice of surgical incision is very important for surgical scars, which is also an important topic in medicine. Choosing a good surgical incision not only facilitates the surgeon to perform the surgery, but also minimizes skin damage and the formation of surgical scars.
The choice of incision is related to the exposure of the surgical field, the latter being a prerequisite for surgery. The ideal incision should have: close and easy exposure of the surgical site, perfect geometry, appropriate length, easy incision and closure, minimal trauma and blood loss.
A grasping or bow-holding grasping scalpel is generally used. These two methods have a wide field of view, allowing viewing of the entire path of the incision from the starting point to the stop point, with free movement and large amplitude, and are suitable for cutting longer incisions. The pen-holding style is suitable for fine cutting and dissection, but the field of view is not open enough, the intended incision path is often obscured by the hand holding the knife, and it is necessary to pause to observe and correct the direction of the incision, which is prone to drift and pause, and the movement is not stretchy enough, so it is not suitable for making larger cuts. It is also not conducive to the formation of small surgical scars.
The incision is made with the scalpel at 45° to the tissue plane and the blade perpendicular to the abdominal wall so as to maintain symmetry between the two edges of the incision. The operator and assistant should pull the tissue with symmetrical force, otherwise the incision bends to the opposite side of the overdrawn incision. The lower part of the straight incision is often bent to the operator’s side because the human elbow is always bent inward. To make a straight incision, this innate tendency must be overcome. The layers of the incised abdominal wall should be in the same plane. This requires that the incision be made perpendicular to the abdominal wall, otherwise the layers of the abdominal wall of the incision will be deflected.
The angle of the incision to the skin, perpendicular to the incision of the skin, has the thinnest surgical scar after healing; the greater the angle of inclination, the wider the surgical scar of the dermis and the more pronounced the skin deformity.
Treatment of surgical scars
At present, domestic and foreign treatment of surgical scars mostly adopts local drug closure, surgical excision implant, crystal abrasion scar, balloon expansion, antibody injection, radiation therapy, compression therapy, hormone therapy, silicone therapy, etc.. All of them are not very mature in clinical practice, some of them take a long time and are painful, and many of them are not satisfactory.
For different surgical scars different restoration plans need to be made so as to achieve effective restoration treatment. Experts say that the treatment of scars should be done at the right time, and different treatments should be done at different times. Post-surgical scars should wait until 3 – 6 months after the formation of scars, that is, after the scar tissue has gradually stabilized before cosmetic surgery can be performed with the best results, or the scars can be stabilized as soon as possible through medication before scar cosmetic surgery. Otherwise, if surgery is performed during the period when the scars are not stabilized, improper post-surgery care, personal physique and other aspects will lead to more serious changes in the scars, and it is very risky to implement surgery without the doctor diagnosing the specific situation of the stabilized scars before surgery. However, in case of dysfunction or aggravation of scar proliferation, it is important to receive professional plastic surgery treatment at an earlier stage.
Although the causes of scar formation are consistent, the degree of scarring is ultimately different for each person due to different surgical sites, different surgical trauma, each person’s body type, and different repair ability.
Prevention of surgical scars
After surgery, it is best to reduce the activity of the wound, otherwise it will affect the wound healing and stimulate the scar formation, which is the reason why scars on the joints of the limbs are usually more obvious.
This is the reason why scars on the joints of the extremities are usually more visible. In addition, the use of silicone film is very effective in preventing the growth of surgical scars. The duration of application of silicone film on scars can be increased from eight hours a day at the beginning to 12 hours after the skin gets used to it, and it takes six months to achieve good results. As for the mechanism of action of silicone film, Quinn believes that it is the chemical effect of continuous release of silicone oil, while Swada and Son believe that it is the physiological effect of hydration and Occlusion that causes the scar inhibiting effect.