When the short-term effects of surgery – such as oozing wounds and incision pain – have long faded, an unseen complication may be lurking beneath the skin. Excess scar tissue, layers deep, can significantly reduce function and movement months after surgery. And on the skin’s surface, visible, lingering scars might be noticeable enough to really bother patients. Before you undergo surgery, here’s what to know about reducing scarring as you heal.
Bend and straighten your elbow. The folds that form in your skin, known as Langer’s lines, represent the direction and orientation of the collagen fibers, similar to the grain of wood, says Dr. Robert Klapper, director of the Joint Replacement Program in Orthopaedic Surgery at Cedars-Sinai Medical Center in Los Angeles. During surgery, it’s not always possible for surgeons to cut parallel to the grain with their scalpels.
“If you are not able, because of heart surgery for example, to get down to the sternum, we as surgeons have to violate the Langer’s line,” Klapper says. “This can often lead to keloids and bumps and poor healing, and extra scar tissue can take place.”
Performing joint surgery, Klapper says, involves cutting into multiple layers of anatomy: the epidermis or skin surface; subcutaneous fat; fascia or connective tissue; muscles, tendons and ligaments; and the lining around the bone called the ostium. “It’s kind of like a seven-layer cake, if you will,” he says. “As a surgeon, you must respect in your repair of the surgery all layers of the seven-layer cake. All should get closed properly.”
