Thyroid disease is a common disease in general surgery and thyroid surgery is one of the most common procedures in general surgery. In recent years, the incidence of thyroid cancer is increasing year by year, and radical thyroid cancer surgery is also increasing year by year. The incision of thyroid surgery is located at the front of the neck, therefore, it is very important to make the skin incision of the neck more beautiful and less obvious. In our clinical work, we often encounter questions from patients, such as: Will the thyroid surgery incision leave a scar? How long is the incision? To answer such questions, there are three aspects that we need to understand.
First, we need to understand the process of trauma repair and incision scar formation. In the process of tissue repair of trauma, there are three different stages.
1, The first stage is the fibrin-filled stage.
2. The second stage is the cell proliferation stage. In the cell proliferation stage, there are intercellular matrix deposits, mainly various collagen and aminopolysaccharides. Most of the collagen is derived from fibroblasts, and the aminoglycans are produced by various cells and play a connecting role between collagen fibers and cells.
3. The third stage is the tissue shaping stage. When there is too much collagen in the scar, it is manifested as the incision scar is too hard and higher than normal skin. As time passes, the organism state gradually improves and part of the collagen and other matrix is absorbed, which is manifested by the incision scar gradually becoming softer and even becoming indistinct. Therefore, we can say that an incision, without the process of scar formation, this incision is difficult to heal. The general scar formation, which is a normal process of tissue healing, can be called normal scarring. Only when the collagen anabolism is hyper-continuous and exceeds the rate of catabolism, and a large number of collagen fibers are formed over a considerable period of time, does it develop into a proliferative scar. Proliferative keloid scars are protruding from the skin surface, irregular in shape, uneven in height, flushed and congested, and solid and tough in texture. There is a burning and itching sensation, and the symptoms are aggravated when the ambient temperature increases, when there is emotional stress, or when spicy and irritating food is eaten.
Next, we need to understand the causes of hyperplastic scarring. There are several factors that can lead to the formation of hyperplastic scars. The main ones are.
1. Systemic factors: such as young adults, women, especially pregnant women and patients with hyperthyroidism are prone to hyperplastic scarring. The occurrence of hyperplastic scarring in the elderly is less common. In male patients, incisional scars with darker skin color and finely latticed skin are also less obvious.
2. Local factors: such as foreign body, inflammation, pulling, etc. Foreign bodies include dust, talcum powder, cotton fiber, thread knots and certain chemicals, etc., and also include keratin precipitated after destruction.
3, other factors: such as personal physical quality, ethnicity, genetics, etc. As for a specific patient, it is difficult to say what causes hyperplastic scarring in each patient.
Finally, it is how to reduce the formation of incisional scar and make the incision heal more aesthetically.
Incision treatment for thyroid surgery.
1, try to choose the naturally formed skin texture of the neck for the incision, the incision scar will be consistent with the skin texture after healing, and the incision scar will not be easy to detect.
2. Try to choose a lower neck incision, referred to as a low collar incision. If the thyroid mass is located in the upper pole of the thyroid gland and the lower incision is not easy to reveal the mass, the incision is adjusted appropriately.
3. Intraoperative attention is paid to the operation to reduce damage, and finer threads are used for suturing and ligature as much as possible (mostly finer No. 0 silk threads are used).
4, intraoperative use of electric knife and electrocoagulation, the power should not be too large to avoid thermal injury.
5.Pay attention to prevent incisional complications such as effusion and infection, and avoid delayed healing of large amount of fibrous tissue formation and formation of obvious scar.
6.Skilled surgical techniques may make up for the difficulty of operating relatively small incisions.
7. Due to the progress of imaging examinations such as ultrasonography and CT examination nowadays, whether there is a lump in one side of the thyroid gland can be clarified before surgery, thus it is not necessary to rely entirely on intraoperative determination as in the past, so a part of the incision can be eliminated and the incision can be made smaller.
8.When placing drainage, a negative pressure drainage device with a puncture needle is used to drain from the side of the thyroid incision to avoid a large scar at the drainage opening.
9. Cosmetic sutures are used. We use 0 silk suture to close the subcutaneous tissue, polypropylene suture inside the skin, no suture can be seen outside the skin, and only a fine suture can be seen after the incision is healed, which has received a better effect.
10. Topical medications to reduce scarring can be applied locally to the postoperative incision, and a silicone gel preparation is commonly used at present.
Figure 1: One month after thyroid surgery
Figure 2: Six months after thyroid surgery
Figure 3: One year after thyroid surgery
Figure 4: Male, six months after thyroid surgery
Figure 5: Three years after thyroid surgery
Figure 6: Six years after thyroid surgery
Figure 7: Eight years after thyroid surgery