How do stitches prevent scarring. What types of sutures are available for wound closure. How long should stitches remain in place for different body parts. What are the best practices for minimizing scars after surgery. How can proper wound care promote better healing outcomes.

Understanding Stitches: Types and Purpose

Stitches, also known as sutures, play a crucial role in treating severe wounds. These small loops of fine, resistant thread hold the edges of a wound together, promoting healing and helping form a neat line. But what exactly are the different types of stitches available?

• Natural or synthetic materials
• Dissolvable or non-dissolvable options
• Subcuticular stitches (run beneath the skin surface)
• Traditional knot-like stitches
• Staples (for large surgical wounds, except on face and hands)

The choice of suture depends on the wound type, location, and desired outcome. For instance, plastic surgeons often prefer subcuticular stitches as they leave minimal scarring.

Alternative Wound Closure Methods

While traditional stitches are common, other techniques can be employed for wound closure:

• “Butterfly stitches” (adhesive tape strips for small wounds)
• Special surgical glue
• Staples (for large wounds, excluding facial areas)

These alternatives may be suitable depending on the wound’s characteristics and location.

Optimal Stitch Duration: A Guide by Body Part

The duration stitches should remain in place varies depending on the body part and the patient’s age. Removing stitches at the right time is crucial for minimizing scarring and ensuring proper healing. Here’s a general guide:

It’s important to follow your doctor’s specific instructions regarding stitch removal timing, as individual cases may vary.

Minimizing Scarring: Best Practices and Techniques

While some degree of scarring is often inevitable, there are several strategies to minimize its appearance:

1. Choose appropriate suture techniques: Subcuticular stitches, favored by plastic surgeons, run beneath the skin surface and typically leave no visible marks.
2. Timely stitch removal: Adhering to recommended removal times helps prevent “track marks” or small white dots of scar tissue.
3. Proper surgical technique: Overly tight stitches can alter wound shape and cause track marks.
4. Avoid staples on sensitive areas: Staples often leave small dots and should not be used on hands or face.
5. Use scar care products: Consult your pharmacist about creams designed to optimize healing and prevent scarring.

Can all scars be completely prevented? While complete prevention may not always be possible, these techniques significantly improve healing outcomes and minimize visible scarring.

Monitoring Wound Healing: Key Signs and Red Flags

Proper wound healing is crucial for minimizing scars and preventing complications. In the days following surgery or wound closure, it’s normal for the site to appear pink and possibly ooze clear fluid or small amounts of blood. However, certain signs warrant immediate medical attention:

• Spreading redness around the wound
• Persistent bleeding that doesn’t stop with pressure
• Severe, unexpected pain
• White or yellow pus discharge
• Fever or general malaise

How can you differentiate between normal healing and potential complications? Pay close attention to changes in wound appearance, pain levels, and your overall health. When in doubt, consult your healthcare provider promptly.

Scar Treatment 101: First Steps in Post-Wound Care

Understanding the scar formation process is essential for optimal wound healing. Scars result from various causes, including accidents, diseases, skin conditions, and surgery. While scars are permanent, they can improve significantly over time.

How long does the scar maturation process take? Scars typically continue to fade for up to two years, depending on factors such as injury severity, wound size, and body location. After this period, further fading is unlikely.

Factors Influencing Scar Formation

• Age
• Heredity
• Ethnicity
• Wound characteristics
• Individual healing tendencies

To minimize scar formation, follow these standard care practices:

1. Apply antibacterial ointments or petroleum jelly to keep the skin moist
2. Change bandages daily to maintain cleanliness
3. Avoid picking at scabs
4. Minimize sun exposure to the injured area

Despite these precautions, scar formation can be unpredictable, resulting in various types such as flat, stretched, depressed, or raised scars.

Advanced Scar Management Techniques

For those seeking to further minimize scar appearance, several advanced techniques and treatments are available:

Topical Treatments

• Silicone-based gels and sheets
• Vitamin E creams
• Onion extract gels

How do these topical treatments work? They often help hydrate the scar tissue, reduce inflammation, and promote collagen remodeling.

Medical Procedures

• Laser therapy
• Microneedling
• Chemical peels
• Steroid injections (for hypertrophic or keloid scars)

These procedures can help improve scar texture, color, and overall appearance. However, their effectiveness may vary depending on the scar type and individual factors.

Surgical Revision

In some cases, surgical scar revision may be recommended for significant improvements. This involves removing the old scar tissue and reclosing the wound using advanced techniques to minimize new scar formation.

When is surgical revision appropriate? It’s typically considered for large, disfiguring scars or those that impair function. Consultation with a plastic surgeon can help determine if this option is suitable for your specific case.

Nutrition and Lifestyle Factors in Scar Healing

While often overlooked, nutrition and lifestyle choices play a significant role in wound healing and scar formation. Optimizing these factors can contribute to better overall outcomes:

Nutritional Support for Healing

• Protein: Essential for tissue repair and collagen production
• Vitamin C: Crucial for collagen synthesis and immune function
• Zinc: Supports wound healing and skin health
• Vitamin A: Promotes epithelial tissue formation
• Omega-3 fatty acids: Help reduce inflammation

How can you ensure adequate nutrient intake for optimal healing? Focus on a balanced diet rich in fruits, vegetables, lean proteins, and healthy fats. In some cases, your healthcare provider may recommend supplements to support the healing process.

Lifestyle Factors Affecting Scar Formation

1. Smoking cessation: Smoking impairs wound healing and increases the risk of complications
2. Stress management: Chronic stress can negatively impact the healing process
3. Adequate sleep: Rest is crucial for tissue repair and overall health
4. Hydration: Proper fluid intake supports optimal skin health and healing
5. Exercise: Moderate activity promotes circulation and overall well-being

By addressing these lifestyle factors, you can create an environment conducive to better wound healing and scar minimization.

The Psychological Impact of Scars: Coping Strategies

While the physical aspects of scar management are crucial, it’s equally important to address the potential psychological impact of visible scars. Many individuals experience emotional challenges related to body image and self-esteem following scarring events.

Common Psychological Challenges

• Anxiety about appearance
• Depression
• Social withdrawal
• Reduced self-confidence
• Post-traumatic stress (in cases of injury-related scars)

How can individuals cope with these emotional challenges? Several strategies can be helpful:

1. Seek professional support: Therapists or counselors can provide valuable coping tools
2. Join support groups: Connecting with others who have similar experiences can be empowering
3. Practice self-compassion: Focus on personal growth and healing rather than perceived flaws
4. Explore scar camouflage techniques: Makeup or specialized products can help minimize scar appearance for special occasions
5. Engage in activities that boost self-esteem: Pursue hobbies, exercise, or other fulfilling pursuits

Remember, scars are often a testament to resilience and survival. Embracing them as part of your unique story can be a powerful step towards emotional healing.

Future Innovations in Scar Prevention and Treatment

The field of wound healing and scar management is continuously evolving, with promising innovations on the horizon. These advancements aim to further minimize scarring and improve overall healing outcomes:

Emerging Technologies

• 3D-printed skin grafts: Customized to match patient’s skin tone and texture
• Gene therapy: Targeting specific genes involved in scar formation
• Stem cell treatments: Promoting regeneration of healthy skin tissue
• Nanotechnology: Delivering targeted treatments to wound sites
• Smart bandages: Monitoring wound healing and adjusting treatment in real-time

How might these innovations change the landscape of scar management? They have the potential to revolutionize wound healing, potentially leading to near-invisible scars or even scarless healing in some cases.

Personalized Medicine Approaches

As our understanding of individual genetic and biological factors in wound healing grows, personalized treatment plans are becoming increasingly possible. This tailored approach may include:

1. Genetic testing to identify scar-prone individuals
2. Customized topical treatments based on skin type and wound characteristics
3. Individualized nutrition and supplement plans
4. Targeted therapies addressing specific healing deficiencies

While many of these innovations are still in development or early stages of implementation, they offer exciting possibilities for the future of scar prevention and treatment.

In conclusion, while complete scar prevention may not always be possible, a combination of proper wound care, advanced treatments, and holistic approaches can significantly minimize scarring and promote optimal healing outcomes. By staying informed about current best practices and future innovations, individuals can take proactive steps towards achieving the best possible results in their wound healing journey.

Scar From Stitches How To Prevent It

1. 
   
   {{link.label}}
   

3 min read

Stitches are an essential part of treating severe wounds. They hold the sides of the wound together so that it heals to form a neat line. There are many different types of stitch or suture (natural or synthetic, dissolvable or non-dissolvable…) which are chosen according to the type and location of the wound. To prevent stitches from leaving scars, it is important to keep to the recommended leave-in time which varies according to the part of the body.

WHAT ARE STITCHES?

Sutures, also known as stitches, are small loops of different types of fine, resistant thread. Their job is to hold a surgical wound together so that it forms a neat line and doesn’t gape or widen. They can be made of many different materials, either natural or synthetic, which are chosen to minimize the chances of adverse reactions.

Other than classic stitches, some small wounds can be closed using “butterfly stitches” (small pieces of adhesive tape) or special glue, while large surgical wounds (apart from on the face) are often closed with staples.

Some are dissolvable and will disappear on their own after a period of weeks (usually about 60 days), while others are non-dissolvable and will need to be removed after a set period depending on the site of the wound. Your doctor will tell you when to make an appointment to have them taken out.

HOW LONG SHOULD

STITCHES STAY IN?

Can stitches stay in too long?

When skin is healing with stitches, it is important to have clear instructions from your doctor on when they need to be removed. See below for a guide to how long stitches should stay in divided by body part. This sheet is made for your information purpose.

SKIN HEALING WITH STITCHES:

WILL MY STITCHES LEAVE SCARS?

How to prevent scarring from stitches

Some stitches leave no marks at all because they run entirely beneath the surface of the skin (the subcuticular technique favoured by plastic surgeons). Traditional stitches that look like knots sewing the wound together can leave little white dots of scar tissue, especially if left in too long, so make sure your doctor has given you clear instructions on when they need to be removed. Surgical technique is paramount as overly tight stitches can cause track marks as well as altering the shape of the wound. Staples will often leave small dots behind, which is why they are never used on the hands or face.

SCAR HEALING AND CARE:

WHAT TO LOOK OUT FOR

How can I make sure my skin is healing properly after surgery?

In the days following an operation or procedure, your wound should look pink and it may well ooze clear fluid or small amounts of blood. Contact your doctor if you notice any of the following:

• redness spreading from the wound site
• bleeding that won’t stop by applying pressure with a clean gauzeaa
• severe pain out of proportion with what your doctor told you to expect
• white or yellow pus oozing from the wound
• you feel feverish or generally unwell

SKIN HEALING CREAM

What scar care should I use to help my skin heal after stitches?

Ask your pharmacist about scar creams to optimise the healing process and help prevent scarring from stitches. It is important to understand that most surgical wounds will leave some kind of scar. The goal is to have the best possible scar by optimising skin healing after surgery.

Click HERE to learn more about scar healing.

Scar Treatment 101: What are the first steps?

Scar formation is a natural part of the skin healing process. It results from accidents, diseases, skin conditions and surgery. Although scars are permanent, they can improve and fade over a period of up to two years based on the severity of the injury, the size of the wound and the location on the body. After this time, it is unlikely they will continue to fade. Some people are also more prone to developing severe scars, with factors such as age, heredity and ethnicity affecting scar formation.

Standard advice in minimizing scar formation includes applying antibacterial ointments or petroleum jelly to keep the skin moist, changing bandages daily to keep the area clean, avoiding scab picking and minimizing sun exposure to the injured area. However, despite these precautions, scarring is often-times still unpredictable and results in many different forms such as flat, stretched, depressed and raised. The scarring process can be frustrating and have a significant impact on quality of life.

There are a variety of treatment options available that can help improve the appearance of scars and reduce associated discomfort. Additional reasons to seek medical care for scars include pain, itching, restriction of movement and psychosocial distress. The type of scar will also influence the kind of treatment your plastic surgeon or dermatologist recommends.

Topical treatments

Topical treatments are usually attempted before pursuing more invasive options. Over-the-counter topical corticosteroids, antihistamine creams and anesthetic ointments can help with healing and maturation of scars by reducing itchiness and discomfort. More potent corticosteroid creams requiring a prescription are sometimes used for newer scars that are pink and still healing to inhibit excessive scar formation.

Silicone has been used for decades in the treatment of scars from surgery, burns and other skin injuries requiring hospital treatment. The sheet form is a soft wound cover that works by sealing the scar and keeping it hydrated. For optimal efficacy, the silicone sheet should be worn for more than 12 hours a day for weeks to months. A more recent development is topical silicone gel, which is self-applied and quickly dries into a thin sheet within 4-5 minutes. Single-use silicone gel formats have been shown to be convenient while remaining cost-effective; they can be found in most pharmacies today.

Injection treatments

Corticosteroid injections are used to treat scars that are raised, thick or red, with more severe forms categorized as keloid or hypertrophic scars. Multiple small injections are made into the scar tissue to reduce local inflammation, itching and pain. Depending on the type of scar and response to a trial of steroid injections, sometimes injections are given at 4-6 week intervals for several months.

On the other hand, filler injections are used to fill depressed scars. Collagen and synthetic agents are injected into or under the scar tissue, producing immediate results. This procedure is mostly performed for cosmetic reasons, and since filler injections are not permanent, the procedure would need to be repeated every few years if desired.

Surface treatments

Skin resurfacing removes the top layer of damaged skin so new, smoother skin layers can form. This allows for improvement in surface irregularities and uneven coloring, making scars less visible.

Dermabrasion uses a rapidly rotating device to manually remove the outer skin layer. This technique is commonly used to minimize skin lines, acne scars, age spots and sun damage. A topical anesthetic may be applied before the procedure, and skin may be sensitive and blotchy for several weeks before returning to normal.

Superficial skin layers can also be removed chemically with chemical peels. There are multiple chemical solution options ranging from light to deep, with deeper chemical peels offering more dramatic results but also longer recovery times. Chemical peels are typically used to treat the face for acne scars, sun damage, wrinkles and melasma. In some cases, they can even help control acne. Some stinging and burning may be experienced during the procedure, and moisturizers and sunscreen are recommended for several weeks afterward.

Laser therapy pulsates concentrated beams of light at irregular skin to precisely remove skin layers. It can help flatten and soften scars, improve discoloration and give skin a tighter, younger-looking appearance. Its precision makes it very effective for small facial and acne scars, although full-facial treatments with weaker laser settings are also frequently done.

Lastly, other surface treatments include vascular laser treatment and skin bleaching. Vascular laser treatment reduces the redness of scars with blood vessels, and skin bleaching involves the use of topical creams that lighten skin.

Surgical treatment

Scar revision surgery can change the positioning and shape of scars. Surgery can also release a tight scar close to a joint to improve movement. The type of anesthesia – local or general – depends on the size and location of the scar. For scar excision and revision, scar tissue is generally removed entirely and a flap of adjacent healthy skin is manipulated to reform the area.

When a flap is not possible, a skin graft taken from another part of the body is used. The graft is usually taken from cosmetically less important areas like the buttocks or inner thighs. This approach is used to replace very large scars. Alternatively, a Z-plasty is a method that moves a scar into a natural fold or crease to minimize its visibility. It can also help relax or release tightness caused by scar tissue.

Another approach involves the use of tissue expanders, in which an expandable silicone implant is placed under the skin. Eventually, the healthy, stretched skin is used to replace the excised scar tissue.

Given the variety of scar treatment options, it is important to consult a board-certified plastic surgeon to determine which treatment is most appropriate for you. Combination therapies may be recommended. Your doctor can go over the risks and benefits as well as realistic expectations of your treatment plan.

The views expressed in this blog are those of the author and do not necessarily reflect the opinions of the American Society of Plastic Surgeons.

Prevention and treatment of pathological scars in surgical practice | Chernyakov A.V.

The article is devoted to the prevention and treatment of pathological scars. The role of drugs with a multicomponent composition, affecting different parts of the process of scar formation, is considered. Described preventive measures aimed at preventing keloid scars, including the use of peeling, dermabrasion, and mesotherapy.

Introduction

The process of rehabilitation of patients in the postoperative period is closely related to wound healing and the formation of a postoperative scar. In most patients with extensive injuries of various etiologies, pathological scars form at the site of the lesion, leading to dysfunction of the limbs, deformities of the body and face, and an increase in the level of disability.
One of the ways to reduce the trauma of the operations performed is to reduce the volume of the surgical wound through the introduction of minimally invasive (endoscopic, laparoscopic, thoracoscopic, etc.) operations and the use of sparing wound closure methods (including intradermal absorbable suture) (Fig. 1).

Morphological process of scar formation

Currently, there is no clear separation of the terms “scar” and “scar tissue” [1]. At its core, a scar is a connective tissue formation that is formed in the process of wound healing, and scar tissue occurs in the last phase of the wound process – the phase of epithelization. The process of scar formation includes external (volume, localization, type of wound healing) and internal factors (reactivity of the body, structural features of the connective tissue, etc.). The severity of the cicatricial process depends on the amount of damage: it is greater in case of deep damage with damage to the sweat and sebaceous glands, hair follicles [2].
In the process of wound healing, several phases are conditionally distinguished, replacing and often overlapping each other: the exudation and inflammation phase, the proliferation phase, and the reorganization phase [3].
In the 1st phase (exudation and inflammation), the blood coagulation system is activated and a platelet-fibrin clot is formed at the site of injury, which leads to bleeding arrest and the creation of a temporary matrix consisting of glycoproteins (collagen), proteoglycans and hyaluronic acid, which serves as the basis for connective tissue synthesis. Subsequently, against the background of fibrinolysis and destruction of platelets, numerous growth factors (transforming growth factor β, epidermal growth factor, insulin-like growth factor, platelet growth factor, etc.) are released and neutrophils are attracted, phagocytizing foreign particles and activating keratinocytes and macrophages.
In the 2nd phase (proliferation), the formation of young connective tissue, rich in blood vessels and cells, and the synthesis of collagen by fibroblasts occur. A feature of this phase is the predominance of embryonic collagen (type III) in the tissues of the postoperative scar, which is thin fibers and is characterized by elasticity and good extensibility. Subsequently, type III collagen is replaced by less elastic type I collagen. At the same time, myofibroblasts synthesize proteins actin and desmin, which improve the convergence of wound edges.
In the 3rd phase of wound healing (the reorganization phase), contractile proteins and various components of the extracellular matrix are synthesized by fibroblasts. Fibroblasts, mast cells and macrophages synthesize matrix metalloproteinases, which destroy the components of the extracellular matrix. Thus, in the reorganization phase, the balance between collagen synthesis and destruction is maintained, which leads to the formation of a normal scar.

Pathogenesis

Reliable reasons for the development of hypertrophic and keloid scars have not yet been identified. The formation of such scars is based on violations of the processes of collagen synthesis and degradation at various stages of scar formation, violations are due to the following reasons [4, 5]:
1) intensification of the synthesis of collagen fibers in the postoperative wound for a long time
time;
2) the influence of various growth factors (transforming growth factor β) on the development of hypertrophic scars by stimulating angiogenesis, collagen synthesis, fibroblast proliferation, inhibition of cytoplasmic matrix degradation [6];
3) increased activity of inhibitors of metalloproteinases, leading to the formation of excess collagen and fibronectin;
4) violations of the processes of apoptosis of fibroblasts of the postoperative wound against the background of suppression of the p53 protein, which is a cell cycle regulator.
Pathological scars can appear at any age, but most often they occur in young patients. This is due to the peculiarities of their skin – elasticity and extensibility due to the synthesis of a large amount of collagen, while in older patients the skin is more rigid.

Scar classification

Currently, the following classification of scars is accepted [2].
I. Physiological (normotrophic) scars.
II. Pathological scars:
1. Atrophic scars:
• stab,
• rectangular,
• rounded,
• striae.
2. Hypertrophic scars.
3. Keloid scars:
A. By etiology:
• true keloid scars,
• false keloid scars.
B. By morphology:
• fibroblastic (active),
• fibrotic (stable).
Normotrophic scars develop as a result of the physiological process of wound healing.
The development of atrophic scars occurs at the site of ulcerative defects, pyogenic infiltrates, infectious granulomas, in foci of chronic inflammation. The main difference between atrophic scars is the absence of cells and blood vessels, dermal atrophy, and severe fibrosis [7]. Stretch marks are also characterized by rupture of elastic fibers along with a deficiency of collagen and elastin.
Hypertrophic scars are characterized by a fairly dense texture, they rise above the surface of the skin, but do not go beyond the damage. Histological examination reveals the growth of collagen fibers, an increase in the number of fibroblasts, and the presence of a developed vascular network [8].
A keloid scar is a neoplasm of immature connective tissue that extends beyond the damage zone and is characterized by the presence of a large number of fibroblasts and obliterated vessels, bundles of collagen fibers forming nodal structures [9].
Currently, the division of keloid scars into true (occurring spontaneously) and false (arising at the site of microtrauma) has undergone some changes, since it has been proven that true keloid scars also occur against the background of microtraumatization of the postoperative wound.

Treatment

The problem of treating patients with keloid and hypertrophic scars has not been completely solved [10]. This is due to the fact that there is no single effective method of managing such patients. Rational tactics for dealing with pathological scars include therapeutic, physiotherapeutic, radiological, surgical and cosmetic methods [11].

Therapeutic methods

Drugs used to treat patients with pathological scars belong to different pharmacological groups and have application points at each stage of scar development [7].
A. Corticosteroid preparations
Corticosteroid drugs are the mainstay in the treatment of patients with keloid scars. Their action is based on the inhibition of the synthesis of inflammatory mediators and fibroblast proliferation, which leads to a decrease in the level of glycosaminoglycans and collagen in the wound [7]. The drugs in this group include:
• Hydrocortisone , used by injection and topically [12];
• Triamcinolone acetate , applied by injection into the damaged area with an interval of 4-6 weeks;
• Betamethasone dipropionate is used in topical forms. A feature of the action of this drug is a decrease in the relief of scar tissue due to changes in the kinetics of fibroblasts and resorption of connective tissue [12].
When using corticosteroid drugs, complications such as skin atrophy, telangiectasia, and pigmentation disorders may develop.
B. Enzyme preparations
Enzyme preparations used in the treatment of patients with pathological scars include collagenases and hyaluronidases that hydrolyze collagen and glycosaminoglycans in scar tissue with further restoration of the normal composition and structure of the extracellular matrix [7].
The specific substrate of hyaluronidase are glycosaminoglycans – “cementing” substance of the connective tissue. As a result of hydrolysis, the viscosity of glycosaminoglycans decreases, the ability to bind water and metal ions. As a result, the permeability of tissues increases, their trophism improves, edema decreases, and the elasticity of scar-modified areas increases. The effect is most pronounced in the initial stages of the pathological process. A problem with many enzyme preparations is their inactivation upon administration. The indicated disadvantage is deprived of the drug Longidase ^® , which is a conjugate of hyaluronidase with a high molecular weight carrier, due to which the clinical effect of the drug is higher than that of the native enzyme. Conjugation increases the resistance of hyaluronidase to the action of temperature and inhibitors, increases efficiency, leads to a prolongation of action, while maintaining the pharmacological properties of the carrier, which has chelating, antioxidant, anti-inflammatory activity. Due to its polytropic properties, Longidase ^® suppresses the reverse reaction aimed at the synthesis of connective tissue components, has an antifibrotic effect, and reduces the severity of the inflammatory reaction. It is well tolerated by patients [7, 13].
To prevent the formation of a hypertrophic scar after surgical operations or in the case of an already formed hypertrophic scar, Longidase is administered intra-scar or subcutaneously near the site of the lesion 1 time in 3 days, with a course of up to 15 injections at a dosage of 3000-4500 IU. Depending on the size and duration of scar formation, it is possible to alternate subcutaneous and intramuscular administration of the drug once every 5 days at a dosage of 3000 IU, with a course of up to 20 injections [13].
Conducted clinical studies demonstrate a significant effect of the drug, which consists in reducing the density of the scar and restoring skin elasticity, in patients with hypertrophic and keloid cicatricial changes with different localization and duration of the pathological process [14, 15].
Currently, a cream containing a stabilized hyaluronidase, Imoferase ^® , has appeared, which can be used by patients themselves at home to continue treatment or care [16]. The cream is applied 2 times a day (preliminary preparation of the skin is not required), it is easily absorbed and does not leave marks on clothes. The clinical efficacy of the drug has been demonstrated by the team of authors of the MGMSU named after M.V. Evdokimov. 1622 patients were examined in 46 Russian medical centers aged 18 to 45 years, with post-traumatic (698 people, 43. 03%), post-burn (98 people, 6.04%) and iatrogenic (826 people, 50.93%) scars. In 372 (22.93%) people, normotrophic types of cicatricial changes in the skin were recorded, in 1250 (77.07%) – hypertrophic ones. As a result of the use of Imoferase ^® cream for 8 weeks. there were statistically significant decreases in the intensity of dyspigmentation by 56.05%, the intensity of blood filling of scar tissue by 38.86%; scar height by 68.47%. Adverse events requiring the abolition or reduction of the frequency of application of the cream were not recorded [17].
In a study conducted in 2016 at the Scientific and Practical Center for Expert Evaluation of the Quality and Safety of Food and Cosmetics “CosmoProdTest”, with the participation of 35 volunteers with hypertrophic scars, the following results were obtained: the thickness of the scar decreased (by 2.1 times) and uncomfortable subjective sensations in the area of ​​the scar (according to the POSAS scale, the symptom “pain” decreased by 1. 9 times, “itching” – by 1.5 times).
Researchers from the Khanty-Mansiysk Clinical Dermatovenerologic Dispensary concluded that Imoferase 9 cream0075 ® is highly effective in topical application, by photophoresis, ultraphonophoresis in patients with hypertrophic scars of various etiologies (30 people took part in the study).
In 2016, at the GKB im. F.I. Inozemtseva (Moscow) were treated in the early stages after injury (up to 3 months) of 30 patients who suffered burns of the II–III degree. Thanks to the use of Imoferase ^® cream, 80% of patients did not develop pathological post-burn scars, and with formed post-burn scars, scar tissue regressed by 1.7 points on the VSS scale.
As for the tolerability of the drug, within the framework of the study in CosmoProdTest, the use of the cream in 25 people with reactive (sensitive) skin did not have an irritating, allergenic and sensitizing effect.
B. Immunomodulators
The use of immunomodulators is a relatively new method of treating patients with pathological scars.
• Interferon -α2b, injected into the suture line after excision of a pathological scar, prevents its recurrence by inhibiting the synthesis of collagen types Ι and ΙΙΙ, which are the main structural components of scar tissue [18];
• Meglumine acridone acetate is an interferon inducer and affects the T-cell link of immunity [7]. The drug has an inhibitory effect on the synthesis of pro-inflammatory cytokines and reduces the level of chronic inflammation in the scar, which stimulates the growth of keloid tissue [7].
D. Vitamin therapy
The use of vitamins locally or by intradermal injection is a new direction in the treatment of patients with pathological scars.
• Retinol ( vitamin A ), accelerates wound healing, inhibits the growth of pathological scar tissue, increases the proliferation of epidermal cells and inhibits the proliferation of fibroblasts. The use of vitamin A leads to inhibition of the growth of keloid fibroblasts and reduces the level of collagen [19];
• Tocopherol ( vitamin E ), an active antioxidant that inhibits lipid peroxidation, stabilizes lysosomal membranes of endotheliocytes, which reduces the degree of endothelial dysfunction [20].
D. Flavonoid Compounds
This group of drugs includes various phytoextracts (quercetin , kaempferol, protocatechin , etc.), which are applied topically as part of various dressings. The effect of flavonoid compounds on the development of scar tissue is explained by their antioxidant properties, the ability to inhibit the process of lipid peroxidation and lipid peroxidation of membrane phospholipids, which affects the activity of endotheliocyte membranes [21]. Inhibition of the production of collagen and fibronectin is also noted due to the inhibition of specific genes involved in the work of some growth factors [11].
E. Amino acids
Currently, the effectiveness of glycine in the treatment of patients with pathological postoperative scars has been most studied. This amino acid is involved in the formation of new cells, has a hydrating ability. The use of glycine locally allows you to maintain the protective function of the epidermis, and its penetration into the dermis improves microcirculation, slows down the degradation of connective tissue. Studies have shown that its use in high doses allows for the prevention of keloid formation due to the endothelioprotective effect of the drug [19].
G. Combined preparations for the treatment of patients with pathological scars
Multicomponent preparations for the treatment of patients with pathological scars are more effective than monocomponent preparations, since they affect different parts of the scar formation process.

Physiotherapeutic methods

These treatments are based on various physical effects on the pathological scar and include:
A. Products containing silicone (plates, plasters, gels) [7]
The effect of silicone plates and patches on keloids is due to their uniform pressure on the scar, which leads to a decrease in the volume of the extracellular matrix and to the correct, ordered arrangement of collagen fibers in the wound. The use of silicone plates allows you to constantly keep the surface of the scar moist, protect it from drying out and traumatization. Constant hydration of the scar tissue helps to restore the water balance of the epidermis and normalize the activity of fibroblasts, which prevents excessive growth of the connective tissue, and exposure to a negatively charged static electric field of silicone can lead to regression of the keloid process [12].
B. X-ray therapy
The use of X-ray therapy is due to the effect of ionizing radiation on the connective tissue, which leads to edema and destruction of both fibroblasts and collagen fibers [22]. A feature of the method is that irradiation affects only the epidermis and superficial layers of the dermis (including the scar), while the load on the underlying tissues is minimal. Contraindications for prescribing X-ray therapy include:
• kidney disease,
• decompensation of circulatory disorders,
• the presence of dermatitis.
The total radiation dose is 15–20 Gy. To prevent the development of a keloid scar, it is possible to irradiate the wound once on the day the sutures are removed.
B. Exposure to low temperatures (cryolysis)
Cryotherapy on a pathological scar (with liquid nitrogen) leads to damage to the vessels of the microvasculature and cell death as a result of the formation of microcrystals inside the cells. The disadvantage of the method is pain and frequent development of hypo- and depigmentations, which in some cases may be irreversible [1].
D. Laser therapy
The use of laser therapy in patients with pathological scars is based on the ability of collagen to contract against the background of local heating (when using a carbon dioxide laser) or to be destroyed during photothermolysis (when using pulsed dye lasers) [1]. The use of lasers leads to a decrease in the size of the scar and its softening. However, when using only laser exposure to a pathological scar, a fairly high percentage of relapses is noted. Therefore, the photophoresis method is of interest, when a drug is first applied to the scar, and then laser irradiation is performed using a contact-stable, quasi-scanning, or contact-labile method. Use low-energy infrared laser radiation (pulse power is 2-8 W / pulse) with a pulse repetition rate of 80 or 1500 Hz. It should be noted that Longidase 9 preparations0075 ® and Imopherase ^® can be used for photophoresis. Longidase is dissolved in water for injection, procedures are carried out daily or every other day with a course of up to 15 procedures. Repeated courses are shown after 2 months. This physiotherapeutic method is most effective for fresh scars from 2 weeks to 2 months ago [15].
E. The use of ultrasonic vibrations in the framework of the method of ultraphonophoresis
The technique is carried out using the combined use of a drug (for example, Longidase or Imoferase) and ultrasonic vibrations in continuous or pulsed mode with a frequency of 880 kHz – 1 MHz. Before use, Longidase is diluted in 1 ml of liquid (sodium chloride solution 0.9%, water for injection, novocaine solution, etc.) and applied to the scar, then, without a time interval, ultrasound is applied using the contact method, the intensity is 0. 2 W / cm2 when the process is localized on the face, and 0 when localized on other parts of the body. .4–0.8 W/cm2. The total duration of the procedure does not exceed 15 minutes, the procedures are carried out daily or every other day with a course of up to 20 procedures. A second course of ultraphonophoresis is allowed no earlier than after 3 months. It is important to note that this method, in combination with intra-cicatrical and subcutaneous (near the site of the lesion) administration of Longidaza, is effective for the treatment of cicatricial changes even more than 1 year old [15].
It should be noted that the effectiveness of the use of therapeutic and physiotherapeutic agents depends on the period of scar formation – the older it is, the less effective the treatment. This is due to the predominance of scar tissue and a decrease in the number of vessels in the connective tissue formation, which disrupts its trophism.

Surgical treatment

Surgical excision of keloid scars is used extremely rarely, because a traumatic effect on the scar almost always leads to a recurrence of the keloid. The method is based on the removal of scar tissue and the creation of optimal conditions for healing by primary intention: comparison of homogeneous tissues and wound edges, cleansing the wound, suturing the wound with an atraumatic absorbable thread. Surgical treatment must necessarily be accompanied by other methods of prevention and treatment of pathological scars [1].

Corrective cosmetic procedures

Currently used cosmetic procedures (peels, mesotherapy, dermabrasion) perform aesthetic correction of small scars, but do not have any therapeutic effect [1]. At the same time, cosmetic methods can be used only in the 3rd phase of scar organization. To obtain satisfactory results, cosmetic procedures must be combined with therapeutic methods.

Prevention of pathological scarring

The healing process of a postoperative wound depends on the amount of damage and the characteristics of the patient’s body. Preventive measures aimed at preventing keloid scars include the use of minimally invasive techniques that reduce trauma to the skin, and the use of various therapeutic and physiotherapeutic agents that prevent the formation of keloid tissue [11]. The use of therapeutic agents for prophylactic purposes should begin already in the 2nd stage of scar formation (proliferation phase). Early initiation of therapy (for example, the appointment of a conjugated hyaluronidase (bovhyaluronidase azoximer) immediately after wound epithelialization) helps prevent the formation of a gross cosmetic defect.

Scar (scar) after abdominoplasty of the abdomen: is there any way to remove it

Abdominoplasty is a surgical intervention, and it requires dissection of soft tissues. Wound healing occurs through scar formation. Plastic surgeons strive to make incisions as minimally traumatic as possible, but scarring and scarring are inevitable. For patients, especially women, they bring aesthetic discomfort. The solution to the problem is possible in two ways – the prevention of the formation of rough scars and the removal of already formed scars.

Stages of postoperative scar formation

Scar tissue is formed in response to massive soft tissue damage. After abrasions and scratches, there are no traces left on the skin, and after cut or stab wounds, including surgical ones, scars form. Scar formation is gradual, going through four successive stages.

1. Inflammation. Continues 3-5 days after the operation. From the center of the wound, granulation tissue grows, which brings the edges of the incision closer together. This healing mechanism is called primary intention. Under favorable conditions, a thin normotrophic scar subsequently forms, which will disappear on its own.
2. Epithelization, formation of a young scar. The duration of the period is up to 30 days. The granulation tissue continues to grow, collagen and elastin fibers are formed in it – the basis of the future scar. The scar is bright pink, as the blood supply is plentiful. Immature tissue stretches easily. Mechanical damage, physical activity during this period contribute to the formation of a coarser scar.
3. Mature scar formation. Lasts up to three months. Collagen and elastin fibers acquire an ordered shape, stacked in bundles. The scar tissue becomes dense, its blood supply decreases, the color becomes pale pink.
4. Final transformation. Scar tissue becomes as dense as possible, whitish. The further behavior of the scar depends on its type – it can disappear on its own or grow to a keloid.

Types of postoperative scars

Postoperative scars are distinguished by the mechanism of formation, appearance, time before self-resorption.

• Normotrophic. Most scars after surgery are normotrophic. Such a scar is located flush with the skin, has a flesh or whitish color. Able to resolve on its own, easy to treat.
• Atrophic. Formed with insufficient growth of granulation tissue, located below the level of the surrounding skin. Whitish, dense, rarely disappear on their own. Discomfort, with the exception of aesthetic, do not bring.
• Hypertrophic – linear and widespread. They rise above the surface of the skin, have a domed shape, bumpy or smooth. At the beginning of formation they have a bright red color, gradually becoming pink. Favorite localization – joints, places of increased friction. A hypertrophic scar is formed within a month after tissue damage, then increases, and after 1-1.5 years begins to decrease.
• Keloid – small and large. Dense nodes with clear boundaries, smooth, rise above the surface of the skin. Coloration from pink to burgundy-purple. They form three months after skin damage, then constantly grow. A feature of the growth of keloid scars is that they go beyond the boundaries of the focus of damage, accompanied by soreness and itching. They do not spontaneously resolve, and after excision they may reappear. Formed in any part of the body.

Methods for preventing the formation of rough scars after surgery

Rough, keloid and hypertrophic scars, not formed after every wound. Their appearance is associated with a violation of cellular metabolism. Scars after abdominoplasty always remain, but in most cases they are thin, pale, and quickly dissolve. It is possible to prevent the formation of rough scars, for this you need to carefully follow the recommendations in the postoperative period.

• Use a compression garment or bandage for one month after plastic surgery. Dense elastic tissue prevents the seams from coming apart, reduces the risk of secondary mechanical damage to the scar tissue.
• Use gels with fibrinolytic, anti-inflammatory, keratolytic components. They prevent excessive growth of granulation tissue in the scar area.
• Use protective and fixing tapes. They close the seam, do not allow the skin around the wound to stretch, and prevent the seam from divergence.
• Use hyaluronic acid for application to the emerging scar in the stage of epithelialization. The drug prevents excessive formation of collagen and elastin fibers.

Repair of broken sutures

In abdominoplasty, the surgeon makes an incision in the skin of the abdomen, removes excess tissue and fat, and then sutures the wound. It is important to follow the doctor’s instructions during the rehabilitation period in order to prevent sutures from coming apart:

• daily treat the wound edges with an antiseptic, gel and cream prescribed by the surgeon;
• avoid sudden movements, tension of the abdominal muscles;
• apply a silicone or gel patch to the wound area;
• to wear a brace.

In the event of suture separation, the attending physician should be contacted for re-suturing the wound. Do not try to fix the edges of the wound yourself. Wrong actions will lead to damage to the granulation tissue, and this contributes to the formation of a hypertrophic scar in the future.

Removal of scars after abdominoplasty

Removal of scars after abdominoplasty is necessary in cases where they are:

• bring aesthetic discomfort;
• steadily increase and do not decrease within a year after the operation;
• accompanied by pain, itching;
• reduce range of motion.

Combination treatment is recommended using the following methods:

• corticosteroid injections into scar tissue;
• chemical peel;
• destruction by liquid nitrogen;
• removal of scar tissue with a carbon or pulsed laser;
• surgical excision of scars;
• short-term exposure.

Normotrophic abdominoplasty scars respond well to treatment even with only one method. In the case of hypertrophic and keloid scars, a combination of 2-3 techniques is required. A combination of liquid nitrogen with corticosteroid injections gives a good effect. Laser resurfacing of scars is carried out after a preliminary peeling course.

Laser resurfacing and chemical peels help to remove atrophic scars. The procedures remove the upper layer of the epidermis, so that the scar is at the level of the skin and does not deform it. Further laser treatment removes the roughness of the scar tissue, and it becomes almost invisible. Laser and peeling can only be used on a healed scar after tummy tuck, that is, after three months.

Surgical excision of scar tissue results in recurrence in 50-100% of patients. This is due to the fact that the scalpel also damages the skin, as at the time of the previous operation. The wound heals according to the same mechanism – increased formation of epidermal cells. To increase the effectiveness of surgical treatment, radiation therapy is added to it.

To remove scars and scars, you can contact the Department of Plastic Surgery and Cosmetology at the SM-Clinic in St. Petersburg. The doctor will examine the scar, determine its type and stage of formation, and select the most effective procedures for restoring skin aesthetics.

Article sources:

1. The use of elements of aesthetic surgery in the reconstruction of the abdominal wall with hernia defects. Medeubekov U.Sh., Magerramov D.M. Bulletin of surgery of Kazakhstan. No. 3. 2017.