One of the less talked about aspects of orthopedic surgery is surgical scar tissue. It’s enormously useful stuff – without it, we would not be able to operate at all. But for a small percentage of our patients, surgical scar tissue will become a problem itself.
Scars are a result of your body’s natural healing process. When you have an injury, the process of inflammation causes your blood to carry white blood cells and microscopic fibers to the injured area. White blood cells attack bacteria and other microorganisms, and fibers begin to wall off and repair the damaged area. The fibers form a strong mesh over the damaged area, tougher often than the surrounding skin.
Scar tissue can be unsightly, and it can sometimes inhibit movement or cause more serious problems. Surgical scar tissue can unfavorably alter joint range of motion, depending on the scar tissue’s location. Post-surgical scar tissue and adhesions can cause discomfort or pain, despite the fact that most scar tissue itself is not sensitive to pain. Scar tissue occurring after surgery may pull on other areas; compress nerves, blood vessels, and organs. Surgical scar tissue can restrict many layers of muscle and connective tissue, which can cause varying degrees of pain or discomfort.
Types of superficial scar tissue
Hypertrophic Scars
When myofibroblasts overproduce collagen during the healing process, a hypertrophic scar may form. This is more common in cases where a wound is infected, inflamed, or subject to a high level of tension, such as an injury over a joint. Burn injuries are prone to hypertrophy, but even mild injuries such as piercings, cuts, and acne can result in these raised scars. Hypertrophic scars are more common in young people and those with higher levels of pigment in their skin. Hypertrophic scars can develop on any part of the body, they can be red or pink, and they are raised less than four millimeters.
Keloid Scars
Sometimes confused with hypertrophic scars, keloids are far more noticeable because they are often considerably larger than the original wound. Keloids are more likely to develop on the ears, shoulders, chest, neck, and back. The risk factors for developing keloids are not fully understood, but there appears to be a genetic predisposition. A family history of keloid scars is a strong indicator of risk. Persons with darker skin are at a higher risk of keloid scarring. Unlike hypertrophic scars, keloids are pink to purple, may grow over time, and are raised more than four millimeters from the skin.
So what can we do when surgical scar tissue becomes a problem?
Topical treatments (over-the-counter or prescription)
These assist with healing and maturation of the scar and may improve the appearance and/or associated symptoms to some degree. Topical treatments may be used on current surface scars and discolorations or to assist with healing following a scar revision procedure. We may recommend the following:
- Topical corticosteroids,anesthetic ointments, and antihistamine creams can reduce itching and tenderness.
- Silicone gel sheeting or ointment may decrease swelling in hypertrophic scars.
- Plant-derived creams, such as Mederma decrease the redness.
Corticosteroid Injections
Injection of corticosteroid agents into hypertrophic and keloid scars is the treatment recommended by most dermatologists. These agents help to reduce scarring by breaking up collagen fiber bonds. The anti-inflammatory effects of the corticosteroids may also reduce itching, redness, and sensitivity.
Physical therapy & massage
To break down adhesions between layers of skin, muscle, fat and fascia, your practitioner may recommend physical therapy and/or massage. A massage can do wonders for scar tissue pain. Your practitioner will use a series of deep tissue mobilization or myofascial release techniques to help reduce inflammation and encourage movement in the affected area. A physical therapist will help you work through certain exercises that can strengthen you muscles and joints so that you can be more mobile again. This is especially helpful if your scar tissue affects major areas of mobility, such as your back, abdomen, and limbs.
Scar revision surgery
When all other treatments have tried and failed to solve the problem, the best course of action may be to cut the badly scarred tissue out and give the body chance to try again. There are several different types of scar resection, revision and removal, and your surgeon will be able to discuss the best course of action with you.
If you are experiencing problems with your surgical scars, call (937) 436-5763 to schedule a consultation with our health practitioners today.