Tuesday, July 28, 2020

Closure of Spinal Deformity Wounds

The long-term appearance of a planned surgical scar is a common concern before surgery.  Sometimes this question is asked to us, other times it is not, likely because people do not want to appear overly concerned or vain about appearance or aesthetics of their skin.  Either way, the concern exists and is valid. Why would anyone want a wide, unattractive scar?

So how do you close the below surgical wound safely and so that it has the narrowest scar long-term?

Our method of wound closure in pediatric spine is influenced by several factors:
1. Location of the wound: Back incisions, though easy to hide under shirts and tops, can easily be seen when the child/adolescent is not wearing a covering (e.g. swimming).
2. Desire to minimize the visibility of the surgical scar.
3. Patient intolerance, anxiety and/or distress when non-absorbable sutures or staples need removal. 
4. We want to avoid the need for additional outpatient visit for surgical wound suture or staple removal

In the operating room, at the end of the surgical procedure, the surgical wound is closed in two layers, the deep spine fascia (black arrow) and the skin (red arrow).  The fascia is a strong covering over the muscle, and this is the first layer to close.  It is important to close this tightly to get the appropriate healing after surgery.

The second layer is the skin (small red arrow in above picture).  This layer is actually closed with two separate suture layers

The first layer is deep dermal layer (red suture in below picture) which closely re-approximates the skin edges.  This takes the tension off the edges of the skin.

The second layer is the subcuticular or epidermal suture (blue suture in picture above).  This uses a small suture woven back and forth just barely underneath the surface of the skin.  It is this layer which gently puts the edges of the skin against each other to minimize the amount of scar tissue which develops.  A gap will require scar to heal the area, and this never leaves an attractive scar.

Lastly the skin in sealed with a glue.  This glue also helps the skin edges to be very close together and minimize motion.  It also nicely seals the skin watertight.  This glue usually starts to fall off about 3 weeks after surgery.

We don’t use sutures, steri-strips or staples in our skin closures.

They don’t leave as nice a wound as we want
We want to avoid our wounds looking like this

Instead this is the way we want our skin closures to look. This is only 4 weeks after surgery!

Next blog post we will show pictures of surgical wounds, after surgery, to demonstrate the nice progression of healing with our technique.