Postoperative scar. Effective ways to deal with post-operative scars. Methods for treating postoperative scars

Any surgical intervention involves human body certain stress. The doctor’s task in such a difficult period for the patient is not only to perform the operation competently and professionally, but also to prepare the patient for the recovery process.

Almost none can be done without sutures, which are a way to connect biological tissues and help reduce bleeding and bile leakage.

Types of seams

To understand how to remove stitches at home, you should know how they differ. Seams are divided into embedded and removable.

Removable sutures are removed after the edges of the wound have fused and are characterized by high strength. They are made on the basis of synthetic and natural materials (mersilene, silk, linen, nylon, nylon), metal staples and wire.

Immersed (non-removable) sutures are made from catgut - a natural material made from the small intestines of sheep and capable of dissolving after some time. The advantage is that they are not rejected by the body. Disadvantage: low strength.

Determining factors

How to remove at home? Moment of removal postoperative sutures directly depends on a number of factors, namely:

the patient's well-being;
nature of the operation;
complications;
characteristics of the disease;
patient's age;
restorative features of the body.

The fixing material is foreign to the body. Therefore, to avoid the onset of the inflammatory process, sutures should be removed in a timely manner. How to remove sutures This is not recommended due to the possibility of infection, which puts the patient’s life at risk.

Timing for suture removal

How to remove stitches at home? What are the consequences of late or premature removal of sutures? When performing this manipulation later than the recommended period, the patient feels discomfort and tension at the suture site. Then tissue ingrowth and wound fester may occur, which will negatively affect appearance scar. It is dangerous to remove stitches ahead of schedule: the edges of the wound may not have time to heal.

Time frame for suture removal:

after 12 days - with amputation;
after 6 days - during surgical operations on the head;
a week later - after a minor opening of the abdominal wall and 9-12 - during deep surgery;
10-14 days - for surgery in the area chest;
14 days - at surgical intervention, produced by elderly people, weakened by diseases and infections, cancer patients (due to a decrease in the regenerative capabilities of the body);
14-20 days - after birth;
7-10 days - after cesarean section.

How to remove stitches at home

Sometimes it happens that for some reason there is no possibility of going to a medical institution. If the recommended healing period has passed, the wound looks prolonged, how can you remove stitches at home for a person who has never encountered this process before, is afraid and does not understand the sequence of actions?

In this case, it is important not to panic, to use all your composure and utmost care. First of all, you need to remove the bandage from the wound and make sure that it is not dangerous to remove the stitch.

If redness or signs of inflammation are detected in this place from self-removal stitches must be discarded and be sure to consult a doctor, since most likely the wound has become infected.

Preparatory process

At the preparatory stage, you should select the tools that will be used to remove the sutures. So how to properly remove stitches at home?

You will need sharp scissors (preferably nail scissors) and tweezers. It is highly not recommended to remove stitches with a knife. It would be ideal if, instead of homemade scissors, you have real surgical scissors on hand. The tools at hand should be sterilized: put them in a pan of boiling water for a couple of minutes, then take them out, put them on a clean towel and let them dry.

The area where the stitches will be removed should be washed with soapy water and wiped with a clean towel. Then wipe with cotton wool soaked in alcohol solution. The main process should be started by making sure that the skin around the stitches is clean. How to remove stitches after surgery at home?

Description of the process sequence

The process of removing sutures should be done in a well-lit place in order to clearly see the slightest nuances.

First, use tweezers to lift the first knot not very high. Then use scissors to cut off the base of the thread and begin to carefully pull it out, preventing outer pieces from getting into the fabric. This should be done until the last thread leaves the scar.

The knot should not be pulled through the skin: it will get stuck and cause bleeding. At the end of the procedure, which is relatively painless (except that there is slight discomfort and tingling during the process of pulling the thread), you should make sure that there are no fragments of sewing material left in the wound. To speed up regeneration skin To prevent infection, the scar site should be treated with a weak composition of iodonate, and then a fixing bandage should be applied.

How to remove stitches from your head at home? It is highly undesirable to do this yourself in hard-to-reach places, on the head, after extensive surgery, as this is fraught with a guaranteed infection. Do not wet or wash stitch cuts with soap. You should not try to remove surgical braces at home: doctors do this in a hospital setting with a special tool. If suddenly blood begins to ooze from the wound, you should stop the independent operation and urgently consult a doctor who will help you finish what you started.

The appearance of the wound and its healing depend on the accuracy of sutures and timely removal. Therefore, it is advisable to have the stitches removed by a medical professional.

You should treat the operated area very carefully, try not to touch it or injure it, because the strength of the skin in this area is minimal - 10% of the norm. It is strictly forbidden to expose an unhealed wound to sunlight, as this will cause darkening of the sore spot. For speedy healing Wounds should be treated with specialized ointments and creams prescribed by a doctor for about six months.

A postoperative scar is traditionally considered a cosmetic defect, however, its main danger lies not in its appearance, but in structural changes in the skin. The fibrous tissue that makes up the scar differs in its properties from healthy epithelial or muscle tissue. Fibrin fibers are tightly pressed together and have no blood vessels and contain few living cells (they cannot be detected at all in old scars).

Anti-scar injections

Before attempting to remove a defect radical methods, worth a try drug treatment. Fibrin is not soluble in aqueous solutions, but can be softened and destroyed by steroid drugs. The drugs are selected only by the attending physician, and injections are carried out only under supervision. To remove postoperative defects, medications are used that contain analogues of adrenal hormones.

A number of specialists also use injections of immunosuppressants and even cytostatics. It has been proven that drugs that suppress the activity of fibroblasts (cells that synthesize fibrin fibers) help avoid tissue scarring. Using work correction immune system It is possible to remove a scar only at the initial stage of formation; 5-6 months after surgery, this type of therapy is no longer relevant. Steroids can be used on old scars too.

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(updated 01/30/2018)

ABOUT One of the most popular myths about scars after plastic surgery is that until the scar matures, you cannot touch it, and only after 6 months you can start doing something with it.

There are others: that the seams need to be wiped with vodka, that in the first months after plastic surgery the patient should strain less, otherwise the scar will become rough, that almost any scar will turn white over time and become hardly noticeable...

Tells Radetskaya Larisa Iosifovna, dermatologist-cosmetologist, candidate of medical sciences, laser therapist and head of the training center on laser technologies, specialist in the correction and treatment of scars.

When should I start dealing with post-surgical scars?

N You can start working with the scar 2-4 weeks after surgery, when the stitches are removed and the scabs have come off.

Signs of pathological scar growth may appear as early as 3-4 weeks. What you should pay attention to? The appearance of additional sensations in the scar (itching, pain), increased brightness, hyperemia, stagnation bluish color indicate that the scar is beginning to actively grow, although normally it should gradually fade. And then it is necessary to include therapeutic procedures that help curb the growth of the scar. The sooner you start this fight, the easier, faster and cheaper it is. will undergo treatment. And the better the end result will be.

This does not mean that 2 weeks have passed - and rather it is necessary to intervene in the scarring process. But if the patient was told to wait for the final result within six months, then he will come to the cosmetologist in six months. And the scar, in the presence of the above symptoms, can grow significantly during this time.

Some operations cannot be done without strong tissue tension: in the T-shaped joint after anchor mastopexy, in the sutures after abdominoplasty or in the “tick” going into the intergluteal fold during body lifting. It is this tension that can cause increased growth of scar tissue: the connective tissue grows, trying to quickly close the wound defect and restore the integrity of the body. This is the law of pathophysiology: before the functional tissue has time to grow, the connective tissue will grow.

Such areas can acquire not only a red, but also a stagnant-bluish tint, since the vessels grow very actively, and the outflow of blood is difficult. Prolonged congestive hyperemia in a large percentage of cases will lead to the appearance of hyperpigmentation.

What if a certain area of the suture does not heal for a long time? ?

Long-lasting inflammation means that the primary adhesion of the wound edges has not occurred. The scar in this area will no longer be perfectly thin. And if you do not help the tissues in such a situation, the scar will either spread and become wide, or rise above the level of the skin.

It is necessary to treat the wound, stimulate tissue regeneration in the problem area, and then begin to work with the scar itself.

Hygiene of sutures (scars)

The seams can be wiped with chlorhexidine or miramistin, but not with vodka. Vodka burns and dries out the delicate young epithelium; its use is completely unjustified. After the surgeon has given permission to shower, wash the sutures with a regular body wash, preferably a pH-neutral one. Scars need to be washed every day. In the scalp - daily or every other day.

These words are confirmed by a very experienced dressing room nurse, who has been working with renowned plastic surgeons for 40 years, caring for the scars of patients after plastic surgery:

“For disinfection, chlorhexidine is sufficient, which does not have such an aggressive effect as vodka. In medicine, vodka is not used as a means of treatment, disinfection or care for postoperative sutures.”

Is it possible to determine in advance how healing and scarring will proceed?

It's very difficult. It is necessary to carefully monitor the scar in order to begin treatment measures on time. Ideally, the body should have an absolutely balanced ratio of collagen (the protein that makes up scar tissue) and the enzyme collagenase (which absorbs excess collagen formed during scarring). Then the scar is formed normotrophic, elastic, soft, does not pull or sag. But, alas, this does not always happen.

In reality, this ratio may be different for people, and it determines what kind of scar it will be: normotrophic, hypotrophic or hypertrophic.

There are people whose collagenase is very active, or whose collagen production is reduced, and they may develop hypotrophic (retracted) scars. In such patients, fillers based on hyaluronic acid can dissolve quickly, in a couple of months, although they should “stand” for 6-8 months. If an insufficient amount of collagenase is produced, collagen dominates and grows, and a hypertrophic scar is formed.

Healing and scarring depends on many reasons: from the activity of enzymes in the human body, from congenital or acquired lack of vitamins, microelements, hormonal profile, immunity, stress.

If a person has already had some kind of intervention, you can guess how the healing will proceed by carefully examining the existing scars. But, firstly, a lot depends on the tension of the tissues during this operation, and secondly, in different areas of the face and body, the skin can heal differently.

The influence of physical activity on scar formation

There is an opinion that for several months after plastic surgery it is advisable to minimize any physical exercise(including sex) to avoid blood flow to the stitches. The rush of blood, the myth goes, can lead to scar growth. Is it so?

Postoperative swelling causes tension in the tissues and stretches the edges of the scar. Filled with extra intercellular fluid tissues compress blood vessels and create hypoxia ( oxygen starvation) and ischemia (decreased blood circulation) of tissues, microcirculation worsens. The next stage will be the growth of scar tissue, and then the body will “sprout” additional vessels in it to compensate for the lack of oxygen and prevent necrosis. Therefore, the faster the tissue can be relieved of swelling, tension and tension that it creates, the more delicately the scar will form.

Adequate physical activity (after the end of the early postoperative period) improves tissue trophism and accelerates the movement of all fluids - lymph, venous outflow, arterial inflow, and therefore accelerates recovery and healing. Of course, we are not talking about doing acrobatic stunts, riding a horse or doing strength exercises on the operated area a week after installing the implants. Typically, it is necessary to limit activity for up to a month, and then you can include light/moderate workload in your life. But lie in bed and wait for the swelling will go away itself, inappropriate. Vascular bundles lie in the muscle layers, and muscle movement helps move fluids into in the right direction, to the collectors that discharge liquids.

Of course, first of all you need to listen to the recommendations of the operating surgeon.. I speak as a specialist who is consulted only with bad scars. The patient may not even think about the fact that scarring can be pathological, and considers his symptoms to be a variant of the norm. This material is a warning and a call to carefully monitor scars in order to prevent a situation where the consequences of “beautification” boldly cross out the effect of “beautification.” And to fix it, it will take a lot of painstaking work over several months.

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

Working with scar

Patients don't know modern capabilities corrections and agree to live with wide, hyperpigmented or bluish scars, enjoying the good shape of the chest or abdomen after surgery. But it is POSSIBLE to improve the condition of almost any scar! We can make the scar flat, improve its color and smooth out the boundary between the scarred surface and healthy surrounding skin.

If healing proceeds without any problems, the scar does not require help or additional intervention. But if itching, pain, or discomfort appears in the scar, this is a reason to consult a cosmetologist with experience in working with such pathology. A thorough examination and palpation, clarification of the characteristics of healing and the characteristics of the patient’s body allow us to build the correct algorithm for working with pathological tissue.

Treatment is selected individually, depending on the specific clinical situation. Some people need to coagulate venous and/or arterial vessels, others need to soften deep scar formations, sometimes directly influence proliferation (cell division and multiplication) in the scar. It is often necessary to relieve tension in surrounding tissues with botulinum toxin, and in atrophic processes, on the contrary, to replenish the required volume of missing tissues. The set of measures almost always includes one or another laser procedure. The more technological capabilities a doctor has in his hands, the more sophisticated the correction will be.

*Patients often call hypertrophic (bulging) or wide, “blurry” scars keloids. It's a delusion. A keloid is uncontrollably growing scar tissue, and one of the main diagnostic criteria is its growth beyond the boundaries of the damage. The fight against keloids is a separate topic.

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

AND Sometimes patients with pathological scars are prescribed only physiotherapeutic procedures: for example, a course of medicinal electrophoresis.

Physiotherapeutic methods perfectly help tissues during different periods of healing: first of all, when there is an urgent need to reduce acute tense swelling of tissues. Magnetic therapy, microcurrent therapy and other classical methods are suitable for this. Remarkable results can be obtained using a low-intensity laser. In addition to drainage, each method has other specific effects: improving arterial microcirculation, increasing oxygenation, increasing mitochondrial cell activity and tissue energy potential.

But as a physiotherapist who defended his dissertation in physiotherapy, I know very well how much the technologies of classical physiotherapy differ in terms of effectiveness and dynamics from the modern possibilities of aesthetic medicine. In no way do I belittle the effectiveness of physiotherapeutic technologies!

Treatment of a patient after anchor reduction mammoplasty. Hypertrophied pulling scars, hyperpigmentation. In the photo: before (application 7 months after surgery) and the result 2 months after 1 BBL+Halo procedure without preliminary preparation and post-laser therapeutic procedures(the patient lives in another city and no longer comes for procedures).

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

N It is necessary to relieve the tension of scar tissue and coagulate the vessels feeding the scar. At the same time, the phrase “removing blood vessels” sounds short, but in reality more than one procedure will be required. The vessels tend to sprout again and again, and their growth will have to be restrained.

A set of measures is required: both to relieve tension and to coagulate the vessels. By coagulating blood vessels, we deprive scar tissue of nutrition. Large veins can grow from small vessels, which are sometimes impossible to coagulate without getting burned: scar tissue is much denser than healthy skin, and heat dissipation in it is worse. And this is one of the reasons to start working with the scar at an early stage: while the pathological vessels have not yet become large, and it is much easier to remove them.

But the vessels begin to grow pathologically due to tension, so it is impossible to single out each topic separately - here is a red scar, it needs to be coagulated, but here is a convex one, inject it. The algorithm is different in each case. For example: first botulinum toxin, enzymes, hormones (or another option). Then laser correction of blood vessels. Then, possibly, laser scar correction.

By the way, the phrase “laser resurfacing” is unprofessional, since it can mean anything. Which type of laser treatment will be needed depends on the condition of the scar and the area in which it is located.

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

Myth: “The longer you wear strips, up to 6 months, the tripe is better protected from stretching."

Strips are completely useless in the later stages. For different zones, the period of their use is different, and the surgeon, when examining right moment the strips will be removed and canceled, since the final adhesion and fusion of the edges of the wound has occurred. The tissues are stitched, and a thin strip of patch on the upper layer of the epithelium does not affect the formation of the scar. If internal tension persists, which stretches the skin, strips cannot help.

Working with scars after blepharoplasty: before and after 2 procedures using a classic fractional erbium laser.

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

Working with scars after removal of biopolymer gel: before and after 2 procedures with a fractional erbium laser:

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

How much does it cost?

E If the patient has limited funds, it is better to come for a consultation and discuss options taking into account financial capabilities. Medicine is not mathematics. It is impossible to say: “I will do everything in one procedure.” Sometimes it is better to excise a complex scar and then begin working on the new scar, in correct timing carrying out supportive and preventive measures.

The cost of treatment depends on the complexity of the work, the number of stages, the quality and area of scarred surfaces, the need to use various medications and botulinum toxin, as well as the level of professionalism of the doctor.

For example, with an anchored breast lift, the total length of the stitches can be 50 cm, or maybe 100 cm. Botulinum toxin needs to be injected both into the scar itself and around the scar - sometimes a whole bottle is needed, which is 500 units. Sometimes more.

Vascular coagulation with BBL broadband pulsed light is done with a small adapter, and the cost of the procedure is determined by the number of flashes.

If it is necessary to include platelet-derived growth factors PRP in therapy, the cost of the procedure depends on the number of tubes used, when the price of one tube for PRP is now 12,000 rubles.

Thus, one procedure for working with scars can cost either 6,000 rubles or 60,000 rubles.

Often patients come immediately for “laser resurfacing” of the scar. But before you start laser treatment, preparation is usually required: bring the scar to a calm state, make sure that it no longer grows, and minimize all risks.

Laser treatment is carried out at intervals of 1-2 months, sometimes less frequently. How many procedures will be needed, and most importantly, which treatment options will be optimal in a particular case, it is impossible to answer without an examination. It all depends on the condition of the scar, timing of treatment, localization. Two or three procedures - in the most ideal situation, when everything is quite good and you want to make the scar almost invisible. If the picture is not so flawless, 4 or 5 procedures or more may be needed. Both laser and non-laser technologies are used.

I sometimes prescribe gels and patches for scar treatment between procedures. They create compression, moisturize the scar and thereby help to restrain its growth.

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

Silicone gels and patches for scar treatment

If the gel or patch is intended to treat hypertrophy or keloid, then it should be used only according to indications: on an already hypertrophied or keloid scar. The task of these agents is to resolve pathologically growing tissue. If such preparations (and these are medicinal covering materials containing active substances) apply to normal scars that are still forming without excess collagen, they can really help Negative influence, and the scar will “spread.”

But if the product is indicated for the treatment of any forming scars, then its composition is different. Special patches are great for protection and moisturization fresh scars and are useful in the postoperative period.

Working with scars after a facelift. From the moment of the first request (first photo) to the first laser correction(last photo) I had to work for 8 months. The earlier the pathological development of a scar is detected, the faster its laser correction is possible:

First visit 8 months after surgery: hypertrophy (convex scar), there is a keloid-like area, congestive hyperemia due to long-term vascular growth, tissue tension, discomfort in the scar.

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

Scar treatment process therapeutic methods: coagulation of vessels was carried out with broadband pulsed light, reduction of tissue tension with botulinum toxin, inhibition of growth and reduction of the density and amount of pathological collagen with hormonal and enzyme preparations within 8 months.

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

First laser correction: fractional Er:YAG without coagulation, in some areas with coagulation to reduce wrinkles and skin contraction.

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

2.5 months after the 1st laser correction

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

Scars after leg lengthening using the Ilizarov apparatus.

1st procedure: Er:Yag fractional laser, 2nd (after 3 months): – Halo. Photos before and 1.5 months after the second procedure:

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

Scars on the scalp

M Can hair grow at the site of the scar on the scalp after a facelift? In place of the scar itself, there is, of course, no scar tissue: there is no hair follicles and other functional cells. But you can reduce the width and volume of the scar, increase the amount of healthy skin around it, using laser and cell technologies, and thus the hair-free area will be reduced. Subsequently, hair can be transplanted into healthy skin next to the scar, which will significantly improve the situation aesthetically.

Covering scars with tattoos

E If you plan to improve the condition of the scar, you do not need to get a tattoo on it. Laser exposure works to damage the skin, but a tattoo will not allow you to use, for example, a broadband laser that is absorbed by paint pigments. And if in the future you want to get rid of the drawing, a lot of additional difficulties will arise.

Hypotrophic scars (pits)

P When working with hypotrophic scars, the specialist’s task is to smooth out the sharp transition from the bottom of the fossa to healthy skin, as well as stimulate the growth of healthy dermal tissue in the atrophy zone. Is it possible to fill a hole with filler? Yes, this is a disguise that needs to be repeated periodically. But it is possible to achieve complete replenishment of the defect and smoothing of the skin at the site of former atrophy.

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

One scar was completely corrected and leveled with the surface of healthy skin after 1 laser procedure, and the neighboring one will require another procedure.

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

A scar on the face after removal of a congenital pigmented nevus with hair growth in childhood. 2 laser correction procedures were performed.

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

Working with hypopigmented (white) scars

B A white scar is scar tissue that lacks the melanin found in healthy skin. White scars can also be very noticeable. For example, hypopigmented scars around the areola after breast surgery.

How to improve the condition of such a scar? We need to reduce the amount of scar tissue and try to replace it with healthy tissue. You can make a couple of classic factional ones laser procedures, and then, to completely level the microrelief and smooth out the boundaries, use the HALO technology. With the help of cold ablation, we remove part of the scar, and during healing, a different collagen will grow - not the same one that healed the scar. In place of scar cells, we stimulate the appearance healthy cells and tissues in which melanocyte cells will appear, producing our natural skin pigment. And then the difference in color between scar and healthy tissue will gradually smooth out.

Is it possible to make scars completely invisible?

It is possible, but not all. Once again, I would like to emphasize that any outwardly similar scars can behave completely differently. Let me also remind you that in this article we are not talking about keloid scars.

Sometimes, if the scar is very large, rough, deformed, and its correction requires a lot of time and effort, it is better to excise it (but before doing this, extinguish the pathological growth and make sure that risks are minimized). Here we need mutual understanding and interaction between the cosmetologist and the surgeon. Next, we even out the color of the scar, help the hyperemia fade, and then reduce its width, height, and volume.

Time is our helper, but time can also be our enemy. We work not only on the scar itself, but also on healthy tissue. Scar tissue will thin out, healthy tissue will grow. The transition between them will become less noticeable, perhaps completely invisible to a prying eye.

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Ask your question

Questions and answers on: treatment of scars after surgery

2010-01-20 19:07:30

Maria asks:

Hello!
In the abdominal area, 10 years ago, there is a hypertrophic scar after surgery. After a year of using Contractubex, the scar did not change in size, but was significantly smoothed out. If for best result laser resurfacing, in the meantime, continue the course of treatment with ointments, which will be more effective: Dermatix or Zeraderm?

Answers Kovalenko Yulia Alexandrovna:

Hello Maria!
I’m glad that you got the effect of contratubex with such a long-lasting scar, congratulations! As for the continuation of treatment and what ointments to use, this is only to the specialist who will directly carry out the procedure for you. Perhaps the effect will be better if you use certain ointments after laser resurfacing.

2016-04-03 18:53:08

Ksenia asks:

Hello. Help me please. I am 34 years old, I suffer from episyndrome, which arose as a result of an operation to remove meningioma of the right frontotemporal region (03.2014), a scar was formed, which is the cause of attacks (as the doctors explained). 9 months after the operation, attacks began, I took Finlepsin retard 200 mg . 2 days a week for 7 months. Attacks 1 time per month, without loss of consciousness, for 1-2 minutes, convulsions on the right side of the face, twitching of the tongue, difficulty breathing. Through side effect I slowly reduced the dose of the drug to 100 mg. 2 days a week.
plus added nootropic drug Cognum (calcium hopanthenate) 250 mg. 3 working days for 1 month. For 4 months. there were no attacks, then there were again 1 day per month. The same, I continue to take Finlepsin retard 100 mg 2 times a day. On the last EEG there were general cerebral changes with symptoms of rhythmic disorganization, with elements paroxysmal activity in the middle temporal and central region on the right. I often experience trembling all over my body, slight twitching of the tongue, numbness of the tongue, palpitations, fear, this happens after taking the drug. Maybe finlepsin provokes seizures? Perhaps I need to change my treatment? Cancel anticonvulsant no one is taking it, maybe there is an alternative? Is it possible to use homeopathy in my case for treatment? I checked my thyroid gland 3 months ago, hormones are normal, blood sugar is also normal. Doctor, please tell me what to do? I'm already completely exhausted in my search. Thank you very much.

Answers Starish Natalya Petrovna:

Hello! Based on the above information, it is impossible to answer your question unambiguously. It is necessary to understand what kind of scar, what kind of scar, i.e. see an MRI image of the brain. Next, check his nutrition - do a blood vessel scan of the head and neck, check his condition cervical spine spine - do a CT scan. EEG alone is not enough to make one decision or another and adjust your treatment.

2015-02-19 11:22:04

Nataly asks:

Good afternoon. I had a laparoscopic cholecystectomy more than 10 years ago, and a year after the operation, during full examination a scar was discovered after healing of the duodenum and gastritis of the stomach. All these years nothing bothered me. For more than 3 months, pain appeared in the right hypochondrium, not associated with eating. I donated blood and had a gastroduodenoscopy and ultrasound. Discovered Helicobacter pylori, Amoxicillin-ratiopharm 1000 mg, Klerimed 500 mg and Omep 20mg at the same time. Diagnosis: chronic gastritis. The doctor answered my questions that it doesn’t matter to me what type of gastritis I have, the acidity was not checked and I need a diet. She warned only about possible diarrhea and does not see the need to monitor the progress of treatment. Question: do you need to know your acidity, follow a diet and is it enough? this survey to determine the cause of pain in the right hypochondrium that continues? What to do?

Answers Vasquez Estuardo Eduardovich:

Good afternoon, Nataly! I answer your questions: Finding out about your acidity is not necessary, because... for us doctors, by the nature of the complaints, it often becomes known; Do I need to follow a diet? - probably the doctor considered it necessary for some reason. We usually attach special importance to diet. Is this examination sufficient to establish the cause of pain in the right hypochondrium that continues? - we consider them sufficient, but complaints, despite treatment, may remain for a long time and will have a tendency to worsen; What to do? - If complaints continue, we advise you to seek a second opinion from a gastroenterologist - only in terms of consultation.

2015-01-19 10:11:10

Marina asks:

Hello! I ask for help. I am 39 years old. In June 2014, I had surgery to remove the uterus, cervix, left ovary, and tubes. Diagnosis: fibroids 18 weeks, large cyst on the ovary. The postoperative period was normal, discharged as planned. After discharge, she continued to be monitored by the attending physician regarding purulent discharge. Treatment: douching with chamomile, tampons with levomekol. Followed up every 2 weeks. The discharge did not stop. I was treated like this for 1.5 months. Then I had to move to Russia. Allocations purchased bad smell and I went to the local doctor. 5 months have passed since the operation. I was sent to the department with a diagnosis of purulent colpitis. They took everything possible tests. But the tests are all normal. There is a large number of leukocytes in the smear. They thought that there was an infiltrate after the operation, they sent for an ultrasound, but they did not confirm it. Treatment was prescribed: douching with chamomile, trichopolum, tampons at night with dimexide + Vishnevsky ointment. After 2 weeks of treatment, I came to the appointment with the same problems + in the evening the temperature rises to 37.3. The doctor said that there were threads sticking out of my inner seam, but he couldn’t remove them because the seam was starting to bleed. By back wall the scar is thin and painful. Continued treatment for another two weeks + tetracycline antibiotics. He said that I had nothing to do in the department. They don't do that. I did all the treatment. Nothing changed! The discharge was purulent, a specific smell appeared again, and in the evening there was a fever. I'm desperate. 8 months after surgery. Inseam painful. Maybe you can recommend something. Blood sugar level is 4.8. SOE, POE are normal.

Answers Sitenok Alena Ivanovna:

Hello, Marina. How can I help in such a situation without seeing you?.. Judging by the description, the situation is not simple. Ideally, contact the doctor who performed the operation. If this is not possible, go to any gynecological hospital!

2015-01-13 10:38:23

Natalia asks:

Hello, Doctor. I ask you for help. I am 3 months post surgery to remove several hemorrhoids and anal fissure excision. After the operation there was a drop of blood only after examination by the surgeon. 2 weeks ago, during an examination, the surgeon said that everything was healing well, there were no wounds, the scar was soft. but every day after stool my pain and cramps get worse. Because of this, I walk around the house a little, sitting half sideways. I rest from pain only at night, in my sleep. and in the morning everything is new. I continue treatment with methyluracil suppositories, but baths do not bring relief. I previously used Anomex and Sediproct suppositories. the doctor says that such pain may be due to endometriosis or osteochondrosis of the sacrum. I ask you to help me with advice, what should I do? Apart from constant pain and spasms, nothing bothers me. How can I alleviate my suffering?

Answers Tkachenko Fedot Gennadievich:

Hello, Natalia. To correctly answer your question, an in-person examination is required to assess the condition of the anal canal wounds. Therefore, I would like to recommend that you contact another qualified proctologist - get a “second opinion”.

2014-12-24 20:55:02

Tatiana asks:

After the operation on the kidney, there was suppuration of the postoperative scar - they opened it up. Then the fistulas, which were twice purulent, were opened. Excision and drainage were performed. 3 cultures showed Pseudomonas aeruginosa sensitive to gentamicin, all were injected with cefatoxime. The improvement was temporary. The abipym was punctured and complete healing of the wound does not occur; the fistulas open in subcutaneous tissue. Treatment lasts 7 months. Please advise further treatment, which drugs and antiseptics are best to use for the wound.

2014-10-26 11:17:59

Olga, 38 years old, asks:

Hello, I am 38 years old. In October 2013, I had hysterectomy with appendages. Necrosis of both ovaries, external endometriosis of both ovaries, wedge-shaped defect of the uterus (scar failure) (as a result of unsuccessful treatment of an in-hospital infection during a caesis section in 2010). Immediately after surgery for 9 months. I used Livial, it had no effect, I suffered from insomnia, I was exhausted from frequent hot flashes, the vaginal mucosa was dry and painful, it was impossible to have a sexual life, the family broke up. In July 2014 (after 9 months of using Livial) I began to apply the estramone 50 patch, total composition. things got better, but I read that you need to add gestagen. Which HRT is optimal for me and WHAT DOSE OF ESTROGEN DO I NEED TO RECEIVE ACCORDING TO AGE. Is Angeliq suitable for me (drospirenone is most similar to natural progesterone), but is the estrogen dose low for my age, and can I even have it? There is also Femoston, Klimonorm, the same patches and gestagen in the table, please advise which is better, because I can’t stand it without HRT, but now from personal bitter experience I am convinced that Livial after extirpation of the uterus and appendages is relatively at a young age It doesn’t help at all, at least it didn’t help me. Yes, and my hair also dries out very much, how to deal with this, I’m afraid of losing long hair, the question is hormones? Thank you in advance for your attention and I look forward to your response

Answers Medical consultant of the website portal:

Hello! Substitute hormone therapy regarding post-castration syndrome - this is a serious treatment that cannot be prescribed “on the Internet” and cannot be selected by a woman on her own. You need to find a competent gynecologist or gynecologist-endocrinologist so that the doctor can assess the condition of your body and select the optimal drug. Take care of your health!

2014-08-27 11:09:16

Natalia asks:

Hello!! I really hope to get an answer.. Here is my mother’s story: She is 73 years old. In November 2012, he was diagnosed with cancer of the left mammary gland T4N2M1G4, mts in s/c l/u 2 kg, infiltrative ductal carcinoma. Immunohistochemistry: EP-(15%), PrR-(-), c-erbB2-(+). Very deformed (retracted) left breast, on it there is a large wound about 8 cm in diameter from which oozing yellow liquid, and a dense tumor in its structure (almost under the armpit), which did not move, as if attached to the bone. Immediately, due to the impossibility of performing an operation, treatment was prescribed: 1. A cycle of 6 chemotherapy according to the FEC regimen (fluorouracil, epirubicin, cyclophosphamide), every 20 days, from December 18, 2012 to April 10, 2013. The results were immediate: after the first drip, the tumor began to decrease, but after the 4th, weakness and pallor were noted, and on the 5th and 6th, except for general severe weakness and swelling there were problems with the veins during and after the administration of the medicine. Veins are burned. The effect of the chemotherapy is good: after the 5th drip, the tumor “gathered” by 60% and began to be mobile, the possibility of surgery became possible. After finishing the chemotherapy, the surgeon sent me for radiation before the operation to make the tumor even smaller. During this examination, he changed the diagnosis to T4N2MxG2 grade IIIB-III class.gr.
irradiation
2. In May-June, radio irradiation of the tumor area was carried out (the armpits and lymph nodes were not irradiated) with a single dose of 2 Gy, a total dose of 60 Gy, with a depth of 70%, on a Varian device with a Linear accelerator - the first 10 irradiations, then for technical reasons the treatment was completed - another 20 sessions - on a regular old gamma machine. the tumor decreased even more. After irradiation, CT analysis: a decrease in the tumor process by 45%, a decrease in the volume of pathological tumor contrast by 65%, the absence of axillary nodes, the absence of the appearance of new lesions. No mts was found in the bones.
In August 2013, an operation was performed - radical mastectomy according to Madden. Also deleted 4 axillary lymph node, in which there were metastases. The operation was difficult and long. The surgeon said that he scraped the infiltrate from the bone millimeter by millimeter.
Epicrisis: Diagnosis: T4 pN2 Mo G2 stage IIIB-III class.gr
Histology: infiltrative ductal carcinoma G2, in 4 lymph nodes of the mts process.
Immunohistochemistry dated 08.2013: Er-(+ 15%), Pr-(-), HER-2\new- (-) negative reaction.
After the operation, AROMAZIN was prescribed. 3 months after the operation, severe lymphostasis began on the side of the operated arm. To monitor the course of the disease, an analysis of the breast tumor marker CA-15-3 was carried out. At a norm of 25 units. : before surgery - 36.7, immediately after surgery - 26.2, 5 months after surgery - 52.6. REA, CEA tests are normal.
RECIDENT
On December 30, 2013, a control CT scan with contrast was performed. Result: Condition after left-sided mastectomy according to Madden. In the left axillary region along the vascular bundle there is an infiltrative inductive process up to 70x30 mm in diameter, along the anterior edge of which, along the midclavicular line, nodular formations of 10 and 13 mm are visible, which intensively accumulate contrast (implantation mts). Similar nodular hyperdense (hypervascular) formations are visualized in the soft tissues of the anterior and left lateral surface of the chest wall along the anterior and middle axillary line at the level of the middle segments of the 3rd, 4th, and 5th left ribs. In m.serratus ant.sin nodular hypervascular formations are visualized (cranicoudally): 7, 9, 10 mm. Conclusion: Ca mammae sin. Condition after radiation therapy and surgical treatment. Infiltration of the left axillary region. Relapse in the muscles of the chest wall on the left.
Surgery is not recommended because There are many metastases, they are small, and they cannot all be removed. During a manual examination by the surgeon, a small, pea-sized tumor was visible and clearly palpable. 01.2014 – relapse was cytologically confirmed.
The first course of chemotherapy was immediately administered (one session) (paclitaxel 230 mg, dexamethasone 20 mg, diphenhydramine, sodium chlorine, sturgeon; controloc 40 mg, eluoxan mg 380). By this time, the tumor had grown and became like two immobile ribs of a bean, inseparable from the bone. The chemotherapy was not easily tolerated, it was clearly visible positive effect The decrease in the tumor is not noticeable. The tumor has even grown a little. We decided to abandon chemistry in favor of superficial irradiation of the metastatic area with a linear accelerator (i.e., electrons) so that, with a favorable result obtained from irradiation, this recurrent tumor could be excised. But due to family circumstances, the start of radiation was delayed. Then, due to low lymphocytes, the start of irradiation was again delayed... From 02/17/2014 to 02/27/2014, a course of irradiation to the relapse site in the left axillary zone + chest wall SVD 18 Gy on a Varian linear accelerator, for technical reasons, irradiation of this zone was completed on 03/20/2014 to 03/31/2014. SVD-14 Gy achieving partial regression...
On March 30, 2014, a repeat immunohistochemical study of the material taken during the operation was performed. Result: Er (++3) -61.5%, Pr(+) - 0.72%, HerB2 (+), Ki-67-12%. Next, the patient took Tamoxifen 20 daily from 04/01/2014 to 06/25/2014 .
A BIOPSY was performed immediately! histologically confirmed mts in the skin of the chest, - infiltrative carcinoma of the second stage of differentiation Er(++), PR(+), HerB2(+).
After the biopsy it started a sharp increase MTS.!!!
07.2014 – CT scan with contrast was performed. Result: recurrence of SA in subcutaneous scars. Axillary lymphadenopathy. MTS in soft fabrics chest wall, mts formation in the right adrenal gland 46x21.. Formation of the left vastus dorsi muscle -21x15, lesion S3 of the right lung, lesion S10 of the left lung, subclavian infiltrate.
07.2014 – bone scintigraphy was performed. There are no skeletal pathologies.
07.2014 due to the strongest pain syndrome and lymphostasis that developed after surgery, an ultrasound was performed upper limb. Conclusion: Acute phlebothrombosis left subclavian vein, secondary lymphostasis of the left arm. Treatment was prescribed with Clexane 0.4 - two months + Detralex 2 tablets - 2 months.
From 16.07 the patient will take pain relief with Fentanyl Sandoz -50 patches, tramadol, morphine (tablets).
LOCUS MORBI: left supraclavicular area l/u 0.5x0.5 cm, scar after skin biopsy in the left subclavian region, healing by secondary intention, medial part of the scar after left mastectomy infiltrate 2x3 cm, below the subclavian scar two skin mts 0.5x0, 5 cm, above the s/o scar three mts 0.5x0.5 cm and one 0.8x1 cm, above the distal part of the s/o scar a zone of hypermia 10x8 cm in the apical part infiltrate 2x2 cm.
Diagnosis: Left mammary gland T4N2M0, grade 3B, local relapse, skin metastases, mts to the lungs, grade 2 gr, pain syndrome.
08/07/2014 – treatment with Faslodex 500 was started. dosage regimen (1+14, then every 28 days).
08/20/2014 – second dose of faslodex.
General condition of the patient now: Heart is normal, minor age-related changes...any acute diseases-No. Observed general weakness. The patient lies almost all the time due to severe constant pain in her arm. Decreased appetite, lost a lot of weight.
Question: While taking the drugs Aromasin and Tamoxifen, which are both aimed at blocking the production of estrogen, the patient experienced clearly negative dynamics, relapse, and growth of Mts. Does it make sense to transfer the patient to Faslodex, which is a drug with the same effect (blocking estrogen production). ?
What can be done in this situation? What treatment might be optimal???? Really looking forward to your reply!!!

Answers Bondaruk Olga Sergeevna:

Good day, Natalia! Honestly, there are a lot of questions about treatment... and it cannot be ruled out that in addition to relapse, there are also post-radiation complications. You can probably try chemotherapy, for example, methotrexate-based regimens - CMF, you can try oral fluoropyrimidines... it is difficult to give advice in in this case without seeing the CT scan and the patient

2014-07-10 05:27:16

Svetlana asks:

Hello, please tell me, 1) if there is an enlargement of the left and left ventricles and there is an aneurysm (written in the anterior septal wall of the apex) after extensive heart attack, and there is a photo of the aneurysm, how can we understand that it is all over the scar, it turns out that there is no dense scar at all? such a conclusion a year after the heart attack, and two months later they wrote an apical aneurysm. It turns out that it increased over the course of the year. Could this be? or as cardiologist consultants wrote to me on the Internet, that these sizes are not very informative and depend on the equipment and the technician and the doctor who performed the ultrasound, this is true and do sizes play a big role, I read that they do (but you can read everything that whatever, but how in practice) 2) with such data, what is recommended, CABG with aneurysm surgery? There may not be an alternative - intravascular methods of treatment? Is age 67 a contraindication for surgery? and is there a positive prognosis without surgery? I read that EF may decrease, but how long does it take for this to happen, maybe it remains stable for many years, do such cases happen? I read that complications after an aneurysm operation are not small, 3) for a year they took both Zilt and Cardiomagnyl, after a year some doctors say to stop Zilt, others Cardiomagnyl, but I think maybe both are needed, because there is a complication of an aneurysm (but there is a medical history duodenal ulcer) please answer my questions

Answers Bugaev Mikhail Valentinovich:

Hello. 1) everything is theoretically possible, and the aneurysm can grow larger (due to tissue dissection, say), and the experience of the diagnostician plays a role. Of course, the size of the aneurysm plays a big role - the larger it is, the greater the volume of the heart muscle that is disabled from work, the higher the risk of a blood clot forming in it, the higher the risk of its rupture. 2) there is only one tactic - CABG with aneurysmectomy. Intravascular treatment is indicated only when small sizes aneurysm, when the issue of its removal is not fundamental. 67 years is not the age for such operations. Without surgery, the prognosis is much worse. EF decreases for everyone, but for everyone differently; many factors influence this. Yes, all operations have their own risk of mortality and complications, but the risk of disease is much higher. It is necessary to operate in good center with extensive experience to reduce these risks. It would be nice to first study and compare the results of the centers’ work over several years, but in practice this is very, very difficult to do. 3) both clopidogrel and aspirin are drugs for the prevention of myocardial infarction. They do not affect the risk of aneurysm thrombosis.

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Types of postoperative scars

In medicine, it is customary to divide postoperative scars into 4 types:

Keloid. It resembles a tumor-like neoplasm, which, like a mushroom, hangs over the skin. The color varies from rich pink to bluish. It has a lumpy and dense surface. Such a scar after surgery is larger than the damaged surface of the epidermis. Causes itching and burning sensations in the patient, inflammation often occurs and pain is felt. Doctors have still not been able to establish the nature of the appearance of such a neoplasm after surgery. Predisposing factors include genetics affecting keloidosis and the location of injury or surgery.

Hypertrophic. Rough and hard scar, raised above top layer skin. It often peels off and leads to the formation of trophic ulcers.

Predisposing sources to its formation are identified:

burns deep type or lacerations;
untimely or poor-quality surgery;
localization of the scar in active areas that are often touched;
genetic factor.

Atrophic. Scars are less noticeable because they are flesh-colored or whitish. They are the result of injury to a large area of skin or fatty tissue.

Physiological or normotrophic. After the wound heals, the mark remains invisible and does not protrude above the upper layer of the epidermis. Soon redness and an increase in size are noted, and sensitivity increases. After 2-3 months, the scar will again become almost invisible. This is how superficial wounds heal after surgery performed by an experienced surgeon. During surgery, the doctor tries to cut the tissue along its natural folds so that cosmetic defects do not occur in the future.

Cosmetology procedures

Treatment of scars after surgery is carried out using cosmetic procedures performed in the office of a dermatocosmetologist. These methods include:

Dermabrasion. During the procedure, the upper part of the epidermis is polished and excess connective tissue is removed. Using this method, the relief of the skin is leveled. Used for hypertrophic scars. Dermabrasion is divided into the following types:
Diamond, during which diamond chips are used.
Microdermabrasion. It is possible to get rid of the scar after surgery using a stream of microgranules.
Laser. Removal is carried out using a laser beam.
Mechanical. You can remove an old scar after surgery using a cutter.
Exposure to cold. Treatment with this method is particularly popular and is known as cryodestruction. Affects healthy tissue around the scar low temperature, which is why it is noted sharp spasm, causing the healing process. Some dermatologists do not favor this method of removing scars after surgery, since it is likely to increase the size of fibrous tissue.
Beech therapy. The size of the old suture can be reduced by irradiating the affected area. Negative side This technique is a hyperpigmented stripe, which remains after manipulation in more than a quarter of patients.

Hardware techniques and surgery

Removal postoperative scars carried out by hardware and surgical excision. It is possible to get rid of the scar through abdominoplasty, during which the aesthetic proportions of the abdomen are restored. Plastic surgeries are also performed to eliminate a cosmetic defect. To avoid complications when removing a scar, you should contact a professional plastic surgeon. The following surgical methods are used to eliminate a keloid scar:

Plastic surgery using local fabrics. During surgical manipulation, nearby localized healthy tissue is used. A technically simple and affordable method. Treatment process It is carried out in a hospital and takes no more than a week.
Expander plastic. Required when getting rid of large areas of scar tissue. During the procedure, the removed suture is replaced with expanders, silicone bags that are inserted under the skin and stretched. This procedure is especially effective in the formation of scars after surgery on the scalp.
Plastic surgery with free skin grafts. Transplantation is carried out layer by layer or with splitting of the thin upper layer of the skin.

Medication

Removal of postoperative scars is also carried out using folk remedies and medications at home. Treatment in this way can only be done after consultation with a doctor, who will recommend the best drug to eliminate the scar. The following medications are used:

"Diprospan". Refers to glucocorticosteroids. It is necessary to spread the cream preparation onto the damaged area of the skin several times a day. The medicine is used in the form of injections injected into the injured area of epithelial tissue.
"Kelofibrase". The area of scar tissue will be reduced if you use a product containing urea and sodium heparin. The substances have anti-inflammatory and regenerating effects. It is recommended to apply immediately after scar formation, since old scars are not easily removed.
"Kontraktubeks". The medicine is available in the form of a gel containing onion extract. After using the drug, the growth of cells that influence the growth of scar tissue is inhibited. Thanks to the allantoin included in the composition, the wound heals faster after surgery and the ability of tissues to bind water increases.
"Kelo-cat." Contains silicone and polysiloxane, which form a film on the top of the scar. It prevents scar tissue from growing. When used, the products are eliminated unpleasant symptoms: itching, burning, inflammation. Similar drugs are Dermatix and Skargard.
"Clearwin." The ointment includes natural substances that penetrate into the deep layers of tissue. By enabling regeneration, it replaces the skin with healthy one.

When removing a scar after surgery, they use a special Mepiderm patch, which is simply glued to the affected area of the skin.

How to avoid scar inflammation after surgery

In order for the scar to begin to heal normally and decrease in size, it is necessary to carefully monitor it and prevent an inflammatory reaction. Do not comb or peel off the resulting crust, as such measures will lead to infection and inflammation. It is recommended to cover the scar with a plaster, especially if it occurs in a child. Don't touch the wound often with dirty hands. If a postpartum scar is noted, then to prevent its divergence and inflammation, refrain from lifting heavy objects. After a shower, soak the scar with a paper towel.

Stage	Duration	Peculiarities
Suture healing	Up to 10 days	The wound is connected by granulation tissue
		Easy divergence of the formed scar due to the tension of nearby localized tissues.
Fibrillogenesis and the formation of a fragile scar	From 10 to 30 days	Reduction in the number of vessels and cell elements.
		Increase in collagen and elastic fibers.
		The extreme areas of the wound are connected by an immature scar, which is easy to stretch.
Formation of a durable scar	Up to 3 months	Increased content of fibrous structures.
		Reduction of cellular elements and blood vessels.
Transformation	From 4 months to a year	Scar tissue matures slowly, and the vessels practically disappear.
		Pallor of the scar.
		In the middle of the stage, the scar becomes dense and hard, and a method by which it can be removed can be figured out.

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