Scar stretching

[mgem]

Hi everyone I know the scar takes months to heal after strip surgery, but what causes scar stretching? thanks

[mgem]

Hi everyone I know the scar takes months to heal after strip surgery, but what causes scar stretching? thanks

[Guest comb]

The main reason for scar stretching I believe is excessive tension at the closure, which greatly depends on the doctor's skill.

[mmhce]

mgem,

You can take a look at this thread:

 

http://hair-restoration-info.c...=746102101#746102101

[mgem]

mmhce thanks for the link good info there, thanks comb,i have still got a few scabs left on one side, but the nurse missed a few of the staples somehow?, so i had to back a few days later, apart from that i think everything is good at this stage thanks spex. I will put some more pics up next week for the 1 month mark. mgem

[Dr. Ricardo Mejia]

I have posted some info below. Hope it helps

 

Scar stretching

[Dr. Alan Feller]

Scar stretching is almost purely a physiolgoical phenomenon, and the surgeon has very little to do with it EXCEPT when he takes a strip that is too wide.

 

To get around that problem, most HT doctors choose to take a long but NARROW strip. This way you can get just as many grafts, but with almost no tension on the closure.

 

That said, a patient with the perfect excision and closure can STILL get scar stretching- even if there was NO tension on the wound. In fact, there are people who can get scar stretch even without a strip being taken. For these patients, a single incision is all it takes.

 

In my experience, patients with very flexible skin tend to be the worst scar stretchers. This is the exact OPPOSITE of what one might think, but there it is.

 

I have found that the very best scar formers are those patients with thick, relatively non-flexible skin. Even after EXTREMELY high tension closures these patients often have nearly invisible scars. Just goes to show that things may turn out to be exactly the opposite of what one might initially think; and it's these paradoxes that make surgery a wonderful challenge.

 

Hope this helps,

Dr. F

[Dr. Ricardo Mejia]

Dr Feller makes a good point. It is well known the patients we worry the most about are the ones with very elastic scalps.

[Dr. Michael Beehner]

I agree with the other two physicians that closure tension and the hyperelasticity of the individual patient are the two biggest factors in ending up with a wider than desired scar. I do think that the parietal corner, where the flat occipital aspect of the donor area curves around toward the area behind the ear and the side of the head, is the area most likely to make a patient unhappy with a wide scar. For that reason, I take a narrower strip in that area as compared with the rear center area.

Three other things that I think help minimize stretching of the scar are the following: First, leaving the sutures in as long as possible. And here staples may be a little better, as they are more non-reactive and less likely to be covered with the skin as it heals. Second, for a couple of months after surgery I ask that the patient try to avoid activities in which the neck is acutely flexed down on the chest, such as doing abdominal crunches or lying in bed on three pillows with the neck bent reading a book on one's chest.

The third thing that can be done is to leave a permanent suture, such as nylon under the skin holding one of the layers together permanently. I prefer the lower dermis for this suture with an inverted knot, usually around three of them in total. It's important to pay more attention to strict sterile technique when leaving a foreign body under the skin.

But, as mentioned, I agree the single biggest factor is the width of strip taken. I tend to be conservative and recently have been a little better about urging patient to do scalp stretching exercises as Dr. Wong does in his practice.

Mike Beehner, M.D.

[mgem]

Thanks for answers, that's surprising over the flexible skin