- First--remember that the wound/cut/incision is not "technically" healed at this point. The wound is just now entering that third phase, the maturation phase, of healing. The stitches need to come out early so that there will not be "stitch marks" or "rail road marks" from the stitches themselves. The area needs to still be protected from tension. Steristrips can do this, but so can a piece of paper tape applied along (or across) the "healed" scar. Both of these allow the strip or tape to have the tension placed on them rather than actual scar. The tensions are the scar will vary depending on its location. The shoulder gets a lot of tension as use of the arm is allowed (If we didn't allow use of the shoulder, it could "freeze" up--that's worse than a wide scar.) The breast/chest skin gets some tension with arm use, but can be decreased by not allowing backward motions of the arm (ie vacuuming) or full stretching, as in reaching for the top shelf.
- Second--protect the scar from the sun. Apply sunscreen daily to the scar, if exposed (face, neck, hand), for 6 months or more. This will allow the red color (as the increased capillaries are absorbed) to fade.
- Third--scar massage helps in the "realignment" of the collagen during the maturation phase (up to two years). It is easier to do scar massage if you use something like cocoa butter, vitamin E, Mederma, Aquafor, or just a favorite lotion. The key here is to do it. Gently massage along the scar. Gently "pinch" the scar up if the scar feels like it is trying to "stick" or adhere to the underlying tissues.
- Fourth--If the scar allows (won't work on areas with great movement), silicone sheeting products can be used. It is hard to use both this and some of the scar massage suggestions at the same time. The Mederma or vitamin E, etc must be cleasned off the skin really well befor applying the silicone sheeting.
Saturday, June 9, 2007
So the stitches are out, What can be done to minimize the scar? Scars may fade, but will not disappear.
Scar revisions are not done for a minimal of 6 months, as we know that scars change, flatten, and fade. Exceptions to this rule are when the scar is obviously creating a tether across a joint (can not straighten the elbow) or deforming (pulling the lower eyelid away from the eye). If the scar appears to be getting "puffier" or thicker, it can often be helpful to inject the scar with Kenalog. This must be done carefully, as the injection can thin the scar/skin (atrophy) and decrease pigmentation in the skin. These risks must be weighed against the benefits expected to be gained.
Other things that can help with healing include: not smoking, good nutrition, and keeping other disease processes under control (ie diabetes and hypothroidism).