Surgical Scars

Whether you sustained a deep cut or a precise surgical incision, there is always a risk of scarring. Surgical scarring and how you heal is a unique experience for each individual. It can be impacted by not only one’s age, but genetics, skin quality, and systemic factors; for example, Diabetes.

Unfortunately, as surgeons, we cannot control these individual factors. A combination of these issues may predispose you to a thicker scar even with pristine surgical technique, a fact of surgery frustrating for the patient and the surgeon.

It is important to know that the scar will continue to change throughout the healing process. At 1-2 weeks the scar often is red and larger due to the inflammatory stage of healing that occurs early after surgery. The inflammatory phase is followed by the proliferative stage, a longer stage in which the body is actively repairing itself. Finally, we enter the remodeling/maturation phase where the collagen alignment within the scar continues to change and can continue to do so for many months.

Scars will begin to fade 6-12 months postoperatively.

At Advanced Podiatry, our goal is to educate our patient’s on the measure they can each take to achieve the most cosmetically appealing scar.

Smoking: Smoking slows healing and increases your risk for scarring.   Nicotine and smoking decrease the circulation to the wound.

Sleep and rest: Proper rest is essential for healing. Avoid exhaustion.

Nutrition: Protein intake is vital for the healing of the skin, bone, and all tissue. A healthy balanced diet and possible supplementation are essential.

Activity: Dressings should be left clean, dry, and intact. Any movement that could cause unnecessary tension and possibly reopen your wound should be absolutely avoided.  After foot and ankle surgery, a cast, cam walker, or surgical shoe are provided; these devices will assist in healing and should be worn as instructed.

Sunlight exposure: Cover your incision while it is healing because getting a sunburn may darken your scar. We always recommend that our patients wear protective clothing and use at least 35 SPF sunscreen on surgical incisions for the first year.

Infection: Redness, swelling, pus, and change in pain can all be signs of infection. If a patient were to have any of these symptoms they should contact our office immediately.

Bathing: Keeping a dressing postoperatively clean, dry, and intact is extremely important.  We always provide our patients with a shower cover to be used the first weeks after their procedure.  If your dressing or surgical wound were to get wet, contact our office and your surgeon immediately.

What is a hypertrophic scar?

A hypertrophic scar is one that is very thickened, red, and raised. Although not particularly dangerous they are cosmetically unappealing and therefore dissatisfying to patients. Since scars shrink over time it is difficult to say whether they require any treatment until often 1 year postoperatively.

What is a keloid scar?

A keloid scar is a more severe form of hypertrophic scar and is usually related to genetic predisposition.  A keloid scar will sometimes extend outside of the original surgical or wound site.

How does our practice treat painful or cosmetically unappealing scars?

Corticosteroid treatments: An injection is considered a first-line treatment for hypertrophic scars. Over time, these may help flatten and soften the scar.

Laser therapy: Laser therapy is more effective in newly formed scars than in older scars. The lasers work by burning and flattening elevated scars. They also target the red and pink pigments in the scars to lighten them.

Physical therapy: Manual cross friction massage and the use of a Graston tool can help to improve movement and decrease the thickness of a scar.

Surgery: After waiting at least a year, a hypertrophic or painful scar can be excised or cut out, and closed again with stitches. This treatment tries to re-heal the injury while eliminating the issues that may have caused the scar in the first place, such as infection, inflammation, or tension.

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