Suture after cesarean section: possible problems and treatment. Features of suture and seamless stretch ceilings What the seam looks like after

Creating the thinnest, most invisible seam possible is an extremely important task when performing plastic surgery on the face. Agree, scars can ruin the best plastic surgery. Therefore, “invisible seam” is my credo and one of the most important goals of my daily work. If you happen to meet my patient, you will hardly notice the slightest traces of a facelift.

In the photo: suture after SMAS lift, on the day of surgery and 8 weeks after it.

I was, of course, pleased to know that my respected colleagues and many informed patients consider the vanishingly imperceptible suture to be one of my professional know-how. The effect of a “seamless” facelift “according to the method of plastic surgeon Kudinova” actually consists of many components. The first of these is the cut.

The art of the perfect cut

In facial plastic surgery, it is important not only to have a thorough knowledge of anatomy (an understanding of how this entire complex complex of muscles, ligaments, bones, fat layer and skin works). It is very good to have an innate “feel for tissue” - an intuitive sense, which (as I see in the example of my students) is not inherent in every plastic surgeon.

The location of the incision and its size must be accurately verified. Precision is especially important when creating an incision in front of the tragus of the ear - in this area, the relatively thick skin of the cheek passes into the thin, delicate skin of the pre-auricular area. An error of just a couple of millimeters - and the magical effect of “invisibility” of the plastic surgeon’s work will inevitably be lost! If you've ever done handicrafts, you'll understand what we're talking about.

Invisible seam - my biggest secret

To prevent the seam from deforming, for each section of the incision, not only threads of different thickness and properties are used, but also different tissue fixation technologies. And for the correct distribution of tension, special invisible technologies of “unloading” fixation are used. This eliminates deformation of the cut line.

Naturally, we strive to hide the seams better. Wherever possible, the incisions are carefully hidden - behind the ears, in the scalp, under the chin. And finally, special attention must be paid not only to the placement of the sutures themselves, but also to proper handling of them after the operation.

A little “witchcraft” and care for a flawless result

Don't think that the plastic surgeon's work ends when the bandage is applied. The seam will become completely indistinguishable if you work a good spell on it in the first week or two after the operation.

We gradually remove the threads and replace them with special glues. We start from the most noticeable place - in front of the tragus of the ear.

A few proprietary secrets, gentle care and the result - in a week we will get a thin pink mark without the slightest signs of skin tightening and microbedsores, which are usually left by threads. So gradually, as healing progresses, we remove threads from other areas of the skin. Each of them has its own deadline, its own techniques and secrets.

In the photo you can see what the seam looks like 3 weeks after the SMAS facelift.

As a result, after a couple of months, only the hairdresser who cuts your hair will be able to find my seam. I want the patient not to have to think about hiding the traces of plastic surgery. Every woman has the right to her little secret.

A friend of mine, a respected and very beloved actress, tells reporters:

— Why do I look so young? I love walks, eat right and go to bed early! And all the beauty comes from mom and dad!”

And, of course, she has every right to do so!

A caesarean section is a delivery surgery during which the baby is removed through an incision in the uterus. Despite all its advantages and sufficient popularity today, young mothers are worried about how the suture after a cesarean section will look after a while (isn’t it ugly?), how noticeable it will be and how long the healing process will take. This depends on what kind of incision the surgeon made, whether complications will arise during the postpartum period, and how competently the woman cares for the operated area of ​​her body. The more informed a woman is, the fewer problems she will have in the future.

The reasons why a doctor decides to perform a cesarean section can be very different. Depending on the delivery process and complications encountered during the delivery, incisions may be made in different ways, resulting in different types of sutures that require special care.

Vertical seam

Through the pages of history. The name of the caesarean section operation goes back to the Latin language and is literally translated as “royal incision” (caesarea sectio).

In the hospital

The first treatment of the suture after a caesarean section is carried out in the hospital.

1. After the examination, the doctor decides how to treat the seam: to avoid infection, antiseptic solutions are prescribed (the same brilliant green belongs to them).
2. All procedures are carried out by a nurse.
3. The bandage is changed daily after a cesarean section.
4. All this is done over the course of about a week.
5. After a week (approximately), the sutures are removed, unless, of course, they are absorbable. First, the knot that holds them is plucked off from the edge with a special tool, and then the thread is pulled out. Regarding the question of whether it is painful to remove stitches after a caesarean section, the answer is unlikely to be clear. This depends on different pain threshold levels. But in most cases, the procedure is comparable to eyebrow plucking: at least the sensations are very similar.
6. In some cases, an ultrasound scan of the suture is prescribed after surgery to understand how the healing is progressing and whether there are any abnormalities.

But even in the hospital, before discharge, no one will be able to tell you exactly how long the suture will take to heal after a caesarean section: the process is definitely individual for everyone and can follow its own, separate trajectory. Much will also depend on how high-quality and competent the home care for the operated area will be.

Home care

Before being discharged home, a young mother needs to find out from a doctor how to care for a suture after a cesarean section without medical assistance, at home, where there will be no qualified medical personnel and professional aids.

1. Do not lift heavy objects (anything that exceeds the weight of the newborn).
2. Avoid heavy physical activity.
3. Do not lie down constantly after a cesarean section, walk as much and as often as possible.
4. If there are any complications, you will need to treat the seam at home with brilliant green or iodine, but this can only be done with the doctor’s permission if the scar gets wet and oozes even after discharge from the hospital.
5. If necessary, watch a special video or ask your doctor to tell you in detail how to treat the seam at home. At first, it is not the scar itself that is wetted, but only the area of ​​skin around it, so as not to burn the fresh wound.
6. As for the timing of how long the suture needs to be treated after a cesarean section, this is determined by the nature of the discharge and other features of scar healing. If everything is in order, a week after discharge will be enough. In other cases, the time is determined by the doctor.
7. To prevent suture divergence, wear a tummy tuck.
8. Avoid mechanical damage after cesarean section: so that the scar is not subjected to pressure and rubbing.
9. Many people doubt whether it is possible to wet a stitch: after discharge from the hospital, you can shower at home without a doubt. However, there is no need to rub it with a washcloth.
10. Eat right for faster tissue restoration and faster healing of scars.
11. By the end of the 1st month, when the wound has healed and the scar has formed, you can ask your doctor how to coat the suture after a cesarean section so that it is not so noticeable. Pharmacies now sell all kinds of creams, ointments, patches and films that improve skin restoration. You can safely apply ampoule vitamin E directly to the scar: it will speed up healing. A good ointment for sutures, which is often recommended for use after cesarean section, is Contratubes.
12. Several times a day (2-3) for at least half an hour, expose your stomach: air baths are very useful.
13. Check with your doctor regularly. It is he who will tell you how to avoid complications, what can and cannot be done, when to do an ultrasound of the suture and whether it is necessary.

So caring for a suture after a cesarean section at home does not require any special efforts or supernatural procedures. If there are no problems, you just need to follow these simple rules and pay attention to any, even minor, deviations from the norm. You should immediately report them to your doctor: only he can prevent complications.

This is interesting! Not long ago, scientists concluded that if the peritoneum is not sutured during a cesarean section, the subsequent risk of speck formation is reduced to almost zero.

Complications

Complications and serious problems with the suture after a cesarean section can occur in a woman at any time: both during the recovery period and several years later.

Early complications

If a hematoma has formed on the suture or it is bleeding, most likely, medical errors were made during its application, in particular, the blood vessels were poorly sutured. Although often such a complication occurs due to improper treatment or careless change of the dressing, when a fresh scar has been roughly disturbed. Sometimes this phenomenon is observed due to the fact that the sutures were removed either too early or not very carefully.

A fairly rare complication is suture dehiscence, when the incision begins to creep in different directions. This can happen after a caesarean section on days 6-11, since the threads are removed within this period. The reasons why the suture came apart could be an infection that prevents the full fusion of tissues, or weights over 4 kg that the woman lifted during this period.

Inflammation of the suture after cesarean section is often diagnosed due to insufficient care or infection. Alarming symptoms in this case are:

• elevated temperature;
• if the suture festers or bleeds;
• its swelling;
• redness.

So what should you do if the suture after a cesarean section becomes inflamed and festers? Self-medication is not only useless, but also dangerous. In this case, it is necessary to consult a doctor promptly. In this case, antibiotic therapy (ointments and tablets) is prescribed. Advanced forms of the disease can only be eliminated through surgery.

Late complications

Ligature fistulas are diagnosed when inflammation begins around the thread used to stitch blood vessels during a caesarean section. They form if the body rejects the suture material or the ligature becomes infected. This inflammation manifests itself months later as a hot, red, painful lump, from which pus may leak from a small hole. Local processing in this case will be ineffective. Only a doctor can remove the ligature.

Hernia is a rare complication after cesarean section. Occurs with a longitudinal incision, 2 operations in a row, several pregnancies.

A keloid scar is a cosmetic defect, does not pose a threat to health, and does not cause discomfort. The reason is uneven tissue growth due to the individual characteristics of the skin. It looks very unaesthetic, like an uneven, wide, rough scar. Modern cosmetology offers women several ways to make it less noticeable:

• conservative methods: laser, cryo-impact (liquid nitrogen), hormones, ointments, creams, ultrasound, microdermabrasion, chemical peeling;
• surgical: scar excision.

Cosmetic suture plastic surgery is selected by the doctor in accordance with the type of incision and individual characteristics. In most cases, everything goes well, so that no external consequences of cesarean are practically visible. Any, even the most serious, complications can be prevented, treated and corrected in time. And those women who will give birth after the CS need to be especially careful.

Wow! If a woman no longer plans to have children, the scar after a planned cesarean can be hidden under... the most ordinary, but very elegant and beautiful tattoo.

Subsequent pregnancies

Modern medicine does not prohibit women. However, there are certain nuances relating specifically to the seam that you will have to deal with when carrying subsequent children.

The most common problem is that the suture after a cesarean section hurts during the second pregnancy, especially in its corners in the third trimester. Moreover, the sensations can be so strong, as if he is about to break apart. This causes panic for many young mothers. If you know what dictates this pain syndrome, your fears will go away. If a period of 2 years was maintained between the cesarean and subsequent conceptions, a discrepancy is excluded. It's all about the adhesions that form during the restoration of wounded tissue. They are stretched by the increased size of the abdomen - hence the unpleasant, nagging pain. You will need to inform your gynecologist about this so that he can examine the condition of the scar using an ultrasound. He can recommend some pain relief and emollient ointment.

You need to understand: the healing of a suture after a cesarean section is very individual, it happens differently for everyone and depends on many factors: the process of childbirth, the type of incision, the state of health of the mother, proper care in the postoperative period. If you keep all these nuances in mind, you can prevent many problems and avoid unwanted complications. After all, at this stage it is so important to give all your strength and health to the baby.

In some cases, for example, during surgery or after childbirth, absorbable sutures are required. For this, special material is used. There are many types of absorbable sutures. The healing time of such wounds depends on many factors. So how long do self-dissolving sutures take to dissolve?

Main types of seams

To answer this question, it is necessary to clarify what the main types of seams exist. Typically this is:

1. Internal. Such sutures are applied to injuries resulting from mechanical impact. Certain types of tissue are used to connect tissue at the site of the tear. Such self-absorbing sutures heal quite quickly. They are often placed on the cervix of women after childbirth. In this case, anesthesia is not required, since this part of the reproductive organ is devoid of sensitivity.
2. External. They can also be applied using absorbable material. After childbirth, such sutures are made when there is a rupture or dissection of the perineum, as well as after operations. If regular material is used, it must be removed 5-7 days after surgery.

It is worth considering that self-absorbing sutures can heal after several weeks. It all depends on the type of material and its composition.

What are absorbable sutures

Self-absorbing sutures are almost always applied. It is extremely rare that surgical material that is resistant to hydrolysis is used for wound healing. Sutures that lose their strength after 60 days are considered absorbable. The threads dissolve as a result of exposure to:

1. Enzymes that are present in the tissues of the human body. In other words, these are proteins that control and accelerate the occurrence of chemical reactions.
2. Water. This chemical reaction is called hydrolysis. In this case, the threads are destroyed under the influence of water, which is present in the human body.

Synthetic braided polyglycolide thread "MedPGA"

Analogues of such surgical material are “Safil”, “Polysorb”, “Vicryl”.

Self-absorbing operations or after childbirth can be performed using MedPGA thread. This surgical material is made on the basis of polyhydroxyacetylic acid. These threads are coated with an absorbable polymer. This is required to reduce wicking and capillarity, as well as to reduce the sawing effect that occurs when the material is passed through tissue.

How long does it take for the MedPGA thread to dissolve?

Self-absorbing sutures applied using MedPGA thread undergo hydrolytic disintegration, which is strictly controlled. It is worth noting that this material is quite durable. After 18 days, the threads retain up to 50% of their strength properties.

Complete resorption of the surgical material occurs only after 60-90 days. At the same time, the reaction of body tissues to MedPGA threads is insignificant.

It is worth noting that such surgical material is widely used for suturing all tissues, with the exception of those that are under tension and do not heal for a long time. Most often, MedPGA threads are used in thoracic and abdominal surgery, gynecology, urology, plastic surgery and orthopedics. However, it is not used on nervous and cardiovascular tissues.

Synthetic braided polyglycolide thread "MedPGA-R"

Analogs of such surgical material are Safil Quick and Vicryl Rapid.

"MedPGA-R" is a synthetic thread made on the basis of polygliglactin-910. This surgical material is coated with a special absorbable polymer. This reduces friction as the thread passes through body tissue, and also reduces wicking and capillarity. Thanks to this surgical material, self-absorbing sutures can be applied.

How long does it take for MedPGA-R threads to dissolve?

"MedPGA-R" is a material that is susceptible to hydrolytic decomposition. Such threads are quite strong. After five days, 50% of their strength properties are retained. Complete resorption occurs only on day 40-50. It is worth noting that the tissue reaction to the MedPGA-R surgical material is insignificant. In addition, threads do not cause allergies.

This material is used for suturing mucous membranes, skin, soft tissues, as well as in situations where short-term wound support is necessary. However, there are exceptions. Such threads are not used on nervous and cardiovascular tissues.

Synthetic braided polyglycolide thread “MedPGA-910”

Analogs of such surgical material are “Safil”, “Polysorb”, “Vicryl”.

"MedPGA-910" is an absorbable thread made on the basis of polygliglactin-910. The surgical material is also treated with a special coating, which reduces the “sawing” effect as the material passes through tissue, as well as reduces capillarity and wicking.

Resorption time of "MedPGA-910"

So, when do self-absorbing sutures applied using the surgical material “MedPGA-910” dissolve? Such threads have a high strength index. However, they also undergo hydrolytic degradation. After 18 days, the surgical material can retain up to 75% of its strength properties, after 21 days - up to 50%, after 30 days - up to 25%, and after 70 days, complete resorption of the threads occurs.

This product is used for suturing soft tissues that are not under tension, as well as those that heal quickly, in plastic, thoracic and abdominal surgery, gynecology, urology and orthopedics. MedPGA-910 should not be used when suturing nervous and cardiovascular tissues.

Monofilament "PDO"

There are not many analogues of such surgical material. This is Biosin, as well as PDS II. Such threads are characterized by a high level of biological inertness, are non-wicking and non-capillary, hydrophobic, do not injure tissue when passing through them, are elastic, quite strong, knit well and hold a knot.

How long does it take for monofilaments to dissolve?

PDO monofilaments are hydrolyzable. As a result of this process, dihydroxyethoxyacetic acid is formed, which is completely eliminated from the body. 2 weeks after suturing, the surgical material retains up to 75% strength. Complete dissolution of the threads occurs within 180-210 days.

As for the scope of application, the surgical material “PDO” is used for suturing and connecting soft tissues of any type, including for suturing cardiovascular tissues of the child’s body, which are subject to further growth. However, there are exceptions. Monofilaments are not suitable for suturing tissues that require wound support for up to 6 weeks, as well as those that are subject to heavy loads. Cannot be used when installing implants, artificial heart valves, or synthetic vascular prostheses.

So how long will it take for the stitches to dissolve?

Next, we will consider everything about what self-absorbing sutures are after childbirth: when they dissolve, do they require care. Do not forget that the timing of wound healing and complete disappearance of threads is influenced by many factors. First of all, you need to know what raw materials the surgical material is made from. In most cases, the threads begin to dissolve 7-14 days after suturing. To speed up the process, a healthcare professional may remove the nodules after the wound has healed. To determine the timing of thread resorption, you should check with your doctor:

1. What stitches were placed?
2. What material were the threads made from?
3. Approximate time frame for dissolution of suture material.

In conclusion

Self-absorbing threads are often used when suturing surgical wounds that are located in the deep layers of tissue, as well as on the surface of the skin. For example, during organ transplantation.

The same surgical material is used for ruptures caused during childbirth. At the same time, a lot of research has been carried out. Their results showed that suture material made from polyglycolic acid completely disappeared after only four months, and material based on polyglactin after three. In this case, self-absorbing sutures will hold the edges of the wound until it is completely healed, and then gradually begin to collapse. If the threads persist for a long time and cause discomfort, then you should seek help from a surgeon or attending physician.

This feels like a painful lump that runs almost from the commissure of the labia, often to the side and back, rarely exceeding 2-3 cm in length. In the first days they rub a lot, causing a lot of suffering, after removing them you will feel relief. Sometimes a cosmetic intradermal suture is applied; it is not felt and is easier to tolerate.

Why do my stitches hurt after childbirth?

Because this is a sutured wound that appears as a result of a rupture or incision in the perineum. In a week it will be much easier for you, but you will fully recover in about 8 weeks, or even six months...

Let's figure out what types of suturings there are, how they are applied and how the woman is subsequently treated.

Internal - applied to tears in the cervix and vagina, they usually do not hurt and do not require any special care. They are applied from absorbable materials, there is no need to remove them, there is no need to process them in any way, there is no need to smear or douche, you just need to ensure complete sexual rest for at least 2 months, because here they are in far from ideal conditions.

In order for the wound to heal well, it needs rest and asepsis. Neither one nor the other can be fully provided; the mother will still have to get up to the child, she will have to walk. It is impossible to apply any bandage in this area, and postpartum discharge creates a breeding ground for microbes, which is why it is quite common for the sewn areas to diverge.

You can sew up the perineum using different techniques and materials, but these are almost always removable options (they will need to be removed within 5-7 days). Most often, if everything goes well, they are removed in the maternity hospital, before discharge.

The treatment of stitched areas in the maternity hospital is carried out by a midwife. This can be done both on the examination chair and directly in the ward. Usually treated with brilliant green 2 times a day. In the first two weeks, the pain is very pronounced, it is difficult to walk, and sitting is prohibited; mothers feed while lying down, eat either standing or lying down.

After the surgical threads are removed and discharged from the maternity hospital, the woman will not be able to sit normally for almost another month. At first, you can only sit sideways on something hard, and even from the maternity hospital you will have to return reclining, in the back seat of the car.

How long does it take for stitches to heal after childbirth?

You will feel discomfort in the area where the perineum was torn for at least 6 weeks. Yes, and care at first will have to be very thorough.

Caring for stitches after childbirth

- Self-absorbing options in the vagina and cervix area do not require special care.

External threads require careful care. Their application is most often done in layers, using removable material.

After applying them, after each visit to the toilet you will have to wash yourself with clean water with the addition of potassium permanganate, and thoroughly dry the perineum with a clean towel.

The pads will need to be changed very often as the wound needs to be dry. While you are in the maternity hospital, the midwife will perform the treatment.

Removing the threads is a low-painful procedure that significantly relieves discomfort.

In the first days, it will be necessary to delay the first bowel movement as much as possible, especially with grade 3 ruptures; in the future, it will be induced using suppositories.

It will be necessary to abstain for some time from cereals and bread, vegetables and other stool-stimulating foods. Usually this does not cause big problems since a cleansing enema is performed before childbirth, which in itself can delay stool.

Dehiscence of suturings most often occurs in the first days or immediately after their removal, rarely later. The cause may be early sitting down, sudden movements, as well as complications such as suppuration. This is not a common complication, which occurs with serious ruptures of the perineum, 2-3 degrees.

If there is inflammation, redness, sharp pain in the perineum, premature removal of the material restraining the perineal rupture before the wound has completely healed is not good, because this will form a rough scar. Your gynecologist will tell you how to treat the wound.

If the early period went well, healing proceeds without complications, after discharge from the hospital only hygienic measures will be required. Bepanten or another softening and healing ointment may be recommended.

When do sutures heal completely after childbirth?

On average, discomfort disappears after 2 weeks, but sex will be unpleasant for at least 2 months after the birth of the child. As it heals, a scar forms, which somewhat narrows the entrance to the vagina, making sex painful.

Choosing the most painless position, which is different for each couple, and using ointments against scars, for example, contractubex, will most likely help you cope with this.

Strange sensations in the vaginal area can bother you for quite a long time, up to six months. However, later they completely resolve.

When you need to suspect that something is going wrong:

- If you have already been discharged home, and the stitched area is bleeding. Sometimes bleeding occurs as a result of wound dehiscence. You won’t be able to fully examine yourself on your own, so hurry back to the doctor.

If internal stitched wounds hurt. Normally, after suturing vaginal tears, there may be slight pain for 1-2 days, but it quickly passes. A feeling of heaviness, fullness, or pain in the perineum may indicate the accumulation of hematoma (blood) in the area of ​​injury. This usually happens in the first three days after giving birth, you will still be in the maternity hospital, tell your doctor about this feeling.

Sometimes suturings fester after discharge from the hospital. In this case, a painful swelling is felt in the wound area, the skin here is hot, and a high temperature may rise.

In all these cases, you should not think on your own what to apply to the wound; you should urgently consult a gynecologist.

No matter how careful and experienced the surgeon is, no matter what modern suture materials he uses, a scar inevitably remains at the site of any surgical incision - a special structure made of connective (fibrous) tissue. The process of its formation is divided into 4 sequential stages, and significant internal changes after fusion of the wound edges continue for at least another year, and sometimes much longer - up to 5 years.

What happens at this time in our body? How to speed up healing, and what needs to be done at each stage to ensure that the scar remains as thin and invisible as possible?TecRussia.ru explains in detail and gives useful recommendations:

Stage 1: epithelization of the skin wound

It begins immediately as soon as the damage is received (in our case, a surgical incision) and continues for 7-10 days.

• Immediately after injury, inflammation and swelling occurs. Macrophages emerge from adjacent vessels into the tissue - “eaters”, which absorb damaged cells and clean the edges of the wound. A blood clot is formed - in the future it will become the basis for scarring.
• On day 2-3, fibroblasts are activated and begin to multiply - special cells that “grow” new collagen and elastin fibers, and also synthesize the intercellular matrix - a kind of gel that fills the intradermal cavities.

• At the same time, vascular cells begin to divide, forming numerous new capillaries in the damaged area. Our blood always contains protective proteins - antibodies, the main function of which is to fight foreign agents, so a developed vascular network becomes an additional barrier to possible infection.
• As a result of these changes, granulation tissue grows on the injured surface. It is not very strong and does not connect the edges of the wound tightly enough. With any, even slight force, they can separate - even though the top of the cut is already covered with epithelium.

At this stage, the work of the surgeon is very important - how smoothly the skin flaps are aligned when applying a suture, and whether there is excessive tension or “tucking” in them. Also, careful hemostasis (stopping bleeding) and, if necessary, drainage (removing excess fluid) are important for the formation of a proper scar.

• Excessive swelling, hematoma, and infection disrupt normal scarring and increase the risk of developing rough scars. Another threat during this period is an individual reaction to the suture material, which usually manifests itself in the form of local edema.
• All necessary treatment of the surgical wound at this stage is done by a doctor or nurse under his supervision. You can’t do anything on your own, and it doesn’t make sense to interfere with the natural healing process yet. The maximum that a specialist can recommend after removing the stitches is to fix the edges with a silicone patch.

Stage 2: “young” scar or active fibrillogenesis

Occurs between 10 and 30 days after surgery:

• Granulation tissue matures. At this time, fibroblasts are actively synthesizing collagen and elastin, the number of fibers is growing rapidly - hence the name of this phase (the Latin word “fibril” means “fiber”) - and they are located chaotically, due to which the scar looks quite voluminous.
• But there are fewer capillaries: as the wound heals, the need for an additional protective barrier disappears. But, despite the fact that the number of vessels in general decreases, there are still relatively many of them, so the developing scar will always be bright pink. It is easily stretchable and can be injured under excessive loads.

The main danger at this stage is that the already fused sutures may still come apart if the patient is overly active. Therefore, it is so important to carefully follow all postoperative recommendations, including those related to lifestyle, physical activity, and medication - many of them are aimed precisely at providing conditions for normal, uncomplicated scarring.

• As prescribed by your doctor, you can start using external creams or ointments to treat the developing seam. As a rule, these are agents that accelerate healing: Actovegin, Bepanten and the like.
• In addition, hardware and physical procedures aimed at reducing swelling and preventing hypertrophy of fibrous tissue give good results: Darsonval, electrophoresis, phonophoresis, magnetic therapy, lymphatic drainage, microcurrents, etc.

Stage 3: formation of a durable scar - “maturation”

During this period - 30 - 90 days after surgery - the appearance of the scar gradually returns to normal:

• If at earlier stages the collagen and elastin fibers were arranged randomly, then during the third phase they begin to rearrange, oriented in the direction of greatest stretching of the edges of the incision. There are fewer fibroblasts, and the number of blood vessels decreases. The scar thickens, decreases in size, reaches its maximum strength and turns pale.
• If at this time fresh connective tissue fibers are subjected to excessive pressure, tension or other mechanical stress, the process of restructuring collagen and removing its excess is disrupted. As a result, the scar may become rough, or even acquire the ability to constantly grow, turning into. In some cases, this is possible even without the influence of external factors - due to the individual characteristics of the body.

At this stage, there is no need to stimulate healing; it is enough for the patient to avoid excessive stress on the operated area.

• If a tendency towards excessive fibrosis becomes apparent, the doctor will prescribe injections to reduce scarring activity - usually corticosteroid-based drugs (hydrocortisone or similar). Collagenase also gives good results. In less complex cases, as well as for preventive purposes, non-steroidal external agents are used -, etc.
• It is important to understand that such therapy should be carried out exclusively under the supervision of a doctor - a dermatologist or surgeon. If you prescribe hormonal ointments or injections yourself, just because the appearance of the suture does not meet expectations or does not look like a photo from the Internet, you can significantly disrupt the process of tissue restoration, up to their partial atrophy.

Stage 4: final restructuring and formation of a mature scar

Begins 3 months after surgery and continues for at least 1 year:

• The vessels that penetrated the ripening scar tissue at the previous stages almost completely disappear, and the collagen and elastin fibers gradually acquire their final structure, lining up in the direction of the main forces acting on the wound.
• Only at this stage (at least 6-12 months after surgery) can the condition and appearance of the scar be assessed, as well as plan any corrective measures, if necessary.

Here, the patient is no longer required to take such serious precautions as in the previous ones. In addition, it is possible to carry out a wide range of additional corrective procedures:

• Surgical threads are usually removed much earlier than the surface of the scar is completely formed - otherwise the scarring process may be disrupted due to excessive compression of the skin. Therefore, immediately after removing the sutures, the edges of the wound are usually fixed with special adhesives. The surgeon decides how long to wear them, but most often the fixation period coincides with the “average” period of scar formation. With this care, the mark from the surgical incision will be the thinnest and most invisible.
• Another, less known, method that is used mainly on the face is. “Switching off” the adjacent facial muscles allows you to avoid tension on the developing scar without the use of a patch.
• Aesthetic defects of mature scars do not respond well to conservative treatment. If hormonal injections and external ointments used earlier did not give the desired result, then at the 4th stage and upon its completion, techniques based on mechanical removal of fibrous excess are used: dermabrasion, peelings and even surgical excision.

Briefly about the most important things:

Stage of scar formation and its timing	Main characteristics	Therapeutic and preventive measures
1. Epithelization of the skin wound as a response to tissue damage (the first few days after surgery)	At the site of injury, the body releases biologically active substances that cause the development of edema, and also trigger the processes of cell division and collagen synthesis.	Careful treatment and suturing of the incision (performed by a surgeon). After the sutures are removed, they can be replaced with a plaster to avoid unnecessary tension on the edges of the wound.
2. “Young” scar (1-4 weeks after surgery)	The production of a significant, usually even excessive amount of collagen continues. Vasodilation and increased blood flow at the site of injury contribute to the formation of a voluminous, soft, red or pink scar.	Application of healing ointments (Solcoseryl, etc.) In the presence of severe swelling and/or the threat of proliferation of fibrous tissue - corrective hardware procedures (microcurrents, lymphatic drainage, etc.)
3. “Maturation” of the scar (from 4th to 12th week)	Excess connective tissue gradually dissolves, blood flow weakens. The scar thickens and fades - normally it becomes flesh-colored to white.	The use of non-hormonal ointments to prevent severe scarring. If there are obvious signs of keloid formation, injections or external application of corticosteroids are required.
4. Final tissue restructuring (from 13 weeks to 1 year).	Collagen and elastin fibers are aligned along the lines of greatest tension in the skin. In the absence of complications, a thin whitish stripe is formed from the loose, voluminous and elastic scar formation, almost invisible from the outside.	Towards the end of this stage, if necessary, you can use any mechanical methods of scar correction: grinding, peeling, surgical excision.

In addition to the local factors mentioned above, the healing processes of surgical incisions largely depend on the following circumstances:

• Age. The older a person is, the slower the damaged tissues heal - but the more accurate the final result will be. Statistically, rough hypertrophic and keloid scars occur more often in patients under 30 years of age.
• Heredity. The predisposition to forming large, uncontrollably growing scars often runs in families. In addition, people with dark and dark skin are more prone to excessive division of connective tissue cells.

Also, the following can disrupt the normal wound healing processes and worsen the final condition of the scar:

• obesity or, conversely, underweight;
• diseases of the endocrine system (hypo- and hyperthyroidism, diabetes mellitus);
• systemic collagenoses (systemic lupus erythematosus, systemic scleroderma, etc.);
• use of medications (corticosteroids, cytostatics, anti-inflammatory drugs).