sheppeyescapee wrote:I guess the reason for my post is looking for recommendations for looking after the scars is there any way of stopping them spreading? I still have one more stage for my chest surgery and then I have a 2 stage lower surgery in the summer (if I lose the weight in time). In the last stage of the chest surgery they will be removing the last bit of breast tissue and repositioning the nipples and removing the scar tissue from the previous surgery. It's on NHS and they don't really give you that much advice and the aftercare is pretty much non-existant once you leave hospital.
The best way to stop scars from spreading is to minimise them in the first place. This means your surgeon has to know about HMS and then listen to you!
'Normal' surgery leaves me with enormous scars - they jut out, go bright red and then spread (without fading). Eventually they fade to a sort of shiny silver colour but it takes >5 years! I've found a few things over the years - surgical staples are bad, misaligned wound margins are bad (turns into a big lump in the scar) and I seem to need less eversion (turning up of the wound edges where they're sutured) than normal. Dissolving sutures come out earlier than they should - before the lowest layers of skin are properly fused together - and permanent ones either form a circular 'dot' scar where they enter and exit, or just get spat out by my body They also tear through the wound margins more readily than in normals. So far my list of tips is:
- don't use staples
- don't let the trainee close up! (this is why I have an enormous set of scars from 30+ staples in my abdomen! they also took them out before the lower layers had closed up so it spread a lot)
- use tiny tiny stitches without leaving big gaps between each stitch - otherwise the gaps just open up and need additional closure later
- use thinnest suture material possible
- try and avoid dissolving sutures, they come out too early
- suture further from the wound margin than normal so they don't pull through
- try and avoid simple interrupted sutures - they place too much strain on the wound edges and tear through. A running stitch or horizontal mattress stitch wuld be better as neighbouring stitches take up some of the strain - horizontal mattress best as the two parallel stitches across the wound spread the tension better
- use bolsters to stop the stitch digging into the skin as it leaves 'train-track' scars
- work laparoscopically if possible
- match the wound edges as precisely as possible - otherwise you end up with a lumpy scar and exra tension across it while it heals
- try and cut in gentle curves as they're easier to stitch than sharp corners!
- believe the patient if they say it still hurts
Hopefully that gives you a few ideas to start from Obviously each of us will heal differently but that seems to work for me.