In the clinic, I am sometimes asked by patients who have had surgery elsewhere: I used to have a thin incision when the stitches were first removed, but why is the scar getting wider later? The answer to this question requires a little knowledge: human tissues are active, unlike sutures, which are sewn on and ready to go. The tensile strength of a skin incision is only about 10% of normal skin at 2 weeks after suturing, and it takes half a year for the strength to gradually return to 80% of normal skin.
Therefore, it can be seen that our new incision is very fragile in the early stage (1 to 3 months) after the surgery, and if it is not protected and the surrounding skin is allowed to exert pulling force on it, the new scar will be pulled wider and wider. And too much tension will give the skin a false signal that will stimulate it to produce more scar tissue to counteract this tension. This is why after each skin lump and scar removal surgery I repeatedly emphasize the need to keep the incision in a low tension state and to take tension reduction measures.
Some of my patients have bought their own scar creams before surgery, but in fact these applied scar medications do not have the effect of reducing wound tension, and the patients think that everything is fine after applying them, instead they ignore the most important thing of reducing the tension of the incision, which is actually the most important thing in the early postoperative period, and casually move the surgical site to widen the scar. Once a wide scar is formed, no scar medicine or laser treatment can make it thin again. I think we can all understand the reason: more expensive scar medicine cannot transform the scar into normal skin, and more advanced laser, whose basic principle is high temperature cautery, cannot turn the formed scar into normal skin, so prevention is important!
If you can actively cooperate within 1-3 months after the surgery, move less in the surgical area, and insist on the external use of the tension reduction tape or skin tension reducer, a very fine scar will eventually be formed, and only then, if there is a protrusion of the scar, it is necessary to use external scar ointment or (laser) grinding, so that the protrusion can be reduced and flattened to achieve the best recovery effect of fine and flat. Therefore, I do not advocate the use of scar creams in the early post-operative period, because it is not a good idea to use external reduction measures afterwards, and it is better to take different methods at different stages.
How do you do the reduction measures? The following is a list of common methods that, as with many diseases, require a joint effort by the surgeon and the patient, and must be strictly followed during the first month after surgery, preferably for three months.
Intra-operative tension reduction measures: (done by the surgeon)
1. the local tension of the surgical incision is reduced to a minimum, so that the incision is designed as far as possible along the skin fold lines or in the direction of the tension of the loosely applied skin (RSTLs).
2. additional incisions or transfer flaps (mobilization of the surrounding skin tissue) are required when the direct closure of the surgical incision is under high tension or will cause deformation of the five senses
3.Closing the incision with at least three layers of tight, firm sutures, not just superficial work, just using the so-called non-removable sutures or glue bonding, while ignoring or even not doing the internal sutures.
The measures for post-surgical de-tensioning are: (done by the patient under the guidance of the doctor)
1. avoiding as much as possible the activities of the surgical site, such as facial surgery, less chewing on the affected side and not too much expression, while the activities of the limbs and neck area should be reduced, especially in the joint areas.
2, the use of cosmetic (reduction of tension) tape, which often appears in the American drama, foreign facial surgery are directly after the cosmetic tape, thin and breathable, but also to reduce the function of skin tension. All parts of the body can be used. Specific reference can be made to Figure 1 and Figure 2.
3.Use skin tension reducer. Mainly used for the torso and other relatively flat, need strong tension reduction force parts. Specific reference can be made to Figure 3.
4. Clean the skin with alcohol or chloramphenicol or Neosporin or saline before using skin tensioner, do not apply ointment, otherwise the tensioning tape or skin tensioner cannot be attached.
Cautions.
1, must be perpendicular to the incision stick beauty tape, in order to effectively reduce the tension.
2. Small tweezers, preferably metal ones without teeth, are available at pharmacies and medical supply stores;
3, in the wound before the removal of stitches to paste the beauty tape, the skin around the incision and small tweezers should be disinfected with alcohol, after the removal of the stitches do not need to be disinfected, wipe clean with pure water, dry and then you can paste;.
4, after the removal of the line beauty tape paste a layer on it, paste too thick is not necessary.
5, beauty tape if you run out and can not buy a moment to the hospital, you can buy online, it is recommended not to buy too cheap. It is too late to use breathable band-aids as a temporary substitute.
6., if the paste where the skin reddening obvious, belong to the skin does not adapt, you can not paste a few days to let the skin rest and paste.
Caution.
1, after the removal of the wound each time the removal of the beauty tape do not use alcohol, so as not to stimulate the skin, switch to ordinary pure water can be, or by washing the face, bath let it fall off on its own;.
2, must be parallel to the direction of the incision to remove the beauty tape, vertical tear tape will be the risk of tearing the incision.
3, beauty tape should not be replaced frequently, generally 3-5 days to replace once, depending on the temperature, whether the tape is clean, whether there are still sticky and other factors.
Precautions.
1.Please refer to the cosmetic adhesive tape for the direction of use of the skin tensioner.
2, skin tensioner can be checked every two days, if loose can be properly tightened as shown in small figure 6 to play the role of tension reduction.
3, if the skin blisters indicate that the tensioner is too tight or the skin does not tolerate, you can rest the skin first without the tensioner, the surface can be coated with eye ointment or Bactroban ointment to protect the blisters, and then use the tensioner after it heals, and reduce the force appropriately.