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?
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:
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).
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.
surgical scar.
3. Patient intolerance, anxiety and/or distress when
non-absorbable sutures or staples need removal.
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
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.
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
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.
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.
(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.
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.
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.