Scar Revision

[blairf83]

Tomorrow I will be having an appointment with my plastic surgeon to discuss re-revising my scar.

My original scoliosis scar (closed using dissolvable sutures) split open at 10 days post op, leaving a very unpleasant looking scar over an inch wide. We assumed it was due to infection. It had to be left open because it was a little infected so took 2 months to close completely. I requested a referral to a plastic surgeon from my scoli surgeon when the scar was about a year old- the surgeon removed the scar tissue and reclosed it using dissolvable stitches as that generally gives the tidiest appearance.
What I discovered once again at 10 days post op is that the original problem was caused not by an infection, but by a sensitivity/allergy to the dissolvable stitches. It opened up again. this time, not as wide. It also got a little infected, and of course couldn't be closed immediately. That one took a month to close fully.
It's been about 6 months since my scar revision, and I'm once again a candidate for the procedure. So tomorrow I will be discussing what closure method we can try this time. I'm guessing he'll probably go for normal stitches. Won't be quite so perfect, but a few little extra suture holes is much better than what I've got now- a big (though a good deal smaller than the original) very brightly colored, fiberous feeling recessed scar... And will also be taking care of scheduling the procedure. I'd hoped to get it out of the way before returning to school, but the scar wouldn't have been old enough to redo. The pain of the procedure is pretty minimal. It's sore but not too bad. The worst part will be not being able to shower properly for a full week.
This is what it looks like now:
http://img.photobucket.com/albums/v1...n/100_1965.jpg

[Lavinia]

Good luck - didn't realise it's already 6 months since your last op. Hope it goes really well this time,

Lavinia

[blairf83]

Well, the appointment wasn't exactly what I wanted to hear, but good none the less.
The plastic surgeon is not pleased with the result (obviously).
He said that there are one of two things going on: He VERY strongly believes it was simply because of the sutures that this happened. But there is a possibility that this is just how my body basically *wants* to heal in that area... In other words, there is a chance of this recurring even with a different type of closure.

But I think I'm going to give it another go. The boarding nurse had already gone home for the day, so I have to call monday to schedule. I'm going to be having it done under conscious sedation (where they drug you just make you sleep instead of making you unconscious) since it worked ok last time.
Either this will be happening really soon, or it will have to be put off until the end of october- I'll be unable to ride my horse for a week afterward, and I have two shows back to back in october (the last two of the season, and I have a High Point Championship riding on these, so I don't want to miss). The latest I could have this done and be ready to show would be the end of September. If not then, my show season will wrap up on the 23rd, and then I'll probably need a week to get caught up in school work. I'm hoping they can fit me in sooner than later!

[Lavinia]

Hope so too, be keeping fingers crossed for you (and the horses),

Lavinia

[mamakay]

Hi Blair,
I am always interested in your scar revision and how brave and determined you are,
You may remember my dtr had the same problem which I felt very alone at facing untill you showed your pic link.
Her's is pretty much the same and much thinner in depth that area. Which always worries me.
It also took a long time and daily bandage changing and constent antibiotics.(In other words hell for her.)
We were told it was not an infection but a reaction to the sutures.
There seemed to be a alot of pressure there I noticed when she came home from the hospital,maybe bc of her posture which was always sitting as she was recovering of course.
So I was not about to tell her how to hold her head differntly which may or may not have helped.
I am wishing you the best in your next revision and hope it will be what you want. You must be a strong and brave person to be so persistent about your scar. I don't know if Stephanie will want to revise hers in the future or not.
Are you using the same Dr.?
Do you thing it is the way your body wants that area to heal also?
Does he recut it and sew it with sutures out and in?
I 'll be thinking of you, good luck and let us know hoe it goes..kay

[Celia]

Blair,

I was wondering if the scar revision worsened the appearance of the area ? How did it look before the plastic surgery ?




Celia

[blairf83]

Celia- In some ways, the revision improved the scar's appearance. In other ways, it made it worse.
I unfortunately didn't ever get any good pictures of my original scar... The roll of pics my mom took of it before my revision didn't develop right. So I will describe it for you.
It was very pale colored. It was shaped kinda like a carrot.... big and round at the top, and then tapering down about 5 inches to where the normal part of my scar began. It was extremely thin and flexible- you could see the bones of my back through them, and feel them clearly. If you moved it around a little, my mom thinks you could feel the edge of some of the hardware in my back. It was quite recessed, since it was only a think layer of skin surrounded by normal fat and muscle tissue.

The new scar is an improvement in that the bottom inch of the revision stayed closed neatly. It's not as wide at the top (tradeoff being that it is the same width the whole way along, of course). And this time the scar tissue is thicker so my bones aren't obvious, and it's not as recessed.

BUT: The color of this one is not as nice. It's not mellowing in color as quick as the first one did, and I'm pretty sure it won't reach that point- when I scar, it usually goes to the color that it will be pretty much immediately.
Also, the tissue is kind of fiberous- not soft and flexible the way the first one. It's not a very comfortable scar. The texture makes it a challenge to get makeup to disguise it and look natural (for ordinary circumstances, I don't care- I wear low back shirts all the time- Nobody has ever acted openly repulsed- in fact, several customers at work (I work at JC Penney's in the junior's department) have said stuff like "Hey! That's cool that you are ok with your scar, etc..." and one mother told me that I was a good role model for accepting my body how it was. But for occasions like my best friend's wedding last month where we had spaghetti strap dresses, I do like to cover it up with some concealer so that people don't spend more time puzzling over it than paying attention to the wedding).
There are hard little dips and ridges in it it because unlike the first time the incision opened, it didn't do so continuously, but rather, opened in a stich here and a few stitches there, which allowed it to widen out.

mamakay- I really do believe that it was a reaction to the sutures- I've read around online for information on vicryl suture reactions, and the information i could find describing it does sound similar. My reasoning behind this is that both times there has been a mild infection with some pus in the wound and a little inflamation. I wouldn't think that would be the case if the skin had simply given out because it was pulled too tight.
I'm just glad that it never got so bad as what these people describe: http://brain.hastypastry.net/forums/...p/t-68673.html
And I still wonder why the rest of my scar didn't do it- maybe it just healed solidly before they started to give.... In retrospect, I think perhaps my bone graft site tried to do the same thing- it also started out really thin and then spread at around the same time.

I will be using the same plastic surgeon because the results were looking to turn out quite well prior to my reaction- at around 8 days post op (my first full day without bandages or steri strips) the scar was actually thinner than the rest of my scar, which is your classic fine white line down your back. He'd done a really fantastic job with it. I had my dream scar for two days. This time we're trying for something a little more permanent. ;-)
He will be once again cutting the scar out, but this time he will use a different closure method. I'm not sure if he did it in a couple layers or just one though. And dopey me, in the excitement of hearing that another surgery was an option, forgot to ask what method he was going to use. So when I phone tomorrow to get a date for the surgery, I'll ask the nurse if she could get that information for me. I'm really not keen on the thought of using another dissolvable suture (I really doubt he;d do that). And I can't imagine using staples for it- first off: YEOWZA. Secondly, I can't imagine a plastic surgeon stapling anything.... So my guess is that it will just be the traditional external suture closure- I really don't care if I have a few extra stich marks. I figure it'll compliment my next tatoo rather nicely- Whenever I manage to draw it correctly, Sally from The Nightmare before Christmas (the frankensteiney type character who goes to pieces and then sews herself back together a couple times) will be on my left shoulder blade... I rather think it suits me.

[blairf83]

Oh my gosh! The hospital can fit me in this saturday for the op! I am just thrilled! I really was worried that i would have to wait until November to have it done- last time there was around a 3 week wait for the procedure!
So now i have five days to get prepared- get ahead in my school work (so I don't have to worry about makeups, or keeping up with class while under the influence of narcotic pain meds, asking my trainer to give me a crash course in driving my horse so I can keep him exercised without riding him and putting pressure on my scar.
I believe I may have thought up a way of showering without getting the wound wet (god I was a mess after 5 days with no real shower the last time. Acne everywhere. I did give myself sponge baths, but somehow it's just not the same. I'm going to buy some tegaderm (its the clear stuff they cover IV's with. My mom always refers to it as opsite....), cut it into strips, and then use it to seal a piece of saran wrap over the gauze. Should be waterproof

[blairf83]

2 days post op

and so far, so good.
I was initially really flipped out because my mom told me he used soluble sutures for the whole thing. But I had my 2 day checkup, and he corrected me on that.. The inside was done with a different type of soluble suture (he says it is made of a completely different compound, so hopefully not allergic to this stuff) out of necessity (since I only had a thin layer of scar tissue covering my spine, the full thickness stuff needed to be closed over it in order for it to work correctly, and you can't just sew it up with normal suture material),but the outermost layer is done in the tidiest external sutures that I have ever seen!

Doesn't hurt too much unless I try to turn my head to look over my shoulder. I was going to go out and work my horse

I AM concerned about going back to school... As with before, no showering for a week. I stopped at the drugstore and picked up some waterproof tape, and hopefully I can figure out some way to rig up a waterproof cover so I *can* shower. My mom washed my hair for me in the sink yesterday, but we don't have time to do that every day, and I'm back to school tomorrow.
Unlike last time, he wants the incision left uncovered. Wearing a shirt over it is real uncomfortable... But I also feel odd walking around school with a back full of black stitches!

http://img.photobucket.com/albums/v1...n/100_1980.jpg

http://img.photobucket.com/albums/v1...n/100_1981.jpg

[SpineWhine]

Glad to hear things went well. If showering is your biggest concern - that is great!!

[Gail]

Hi Blair,

Glad you have this behind you. Your scar looks nice.

I did not take a shower for 17 days after my sugery. I took sponge baths. The morning before I went to have my staples removed...I showered. Then once the stapled were removed I waited another week.

In the hospital my surgeon told me I could shower before going home...the nurses told me they didn't recommend taking a chance on getting it wet. I opted for being over cautious. I didn't want any bacteria from my hair etc. running down on the incision. There was no way I wanted to go back through surgery...I was not interested in any refresher courses. So, if I was you with all the incision problems you have had...I'd suggest sponge baths and go to the beauty shop and let them wash your hair.

Kindest Regards,
Gail

[blairf83]

Well, the stitches came out friday. Today was a little worrisome day because the scar has spread out some and there is a little dip in it that wasn't there the day before. I had my mom steri strip me with longer steri strips that basically pulled on my skin whenever I put my shoulders forward and came close to putting pressure on the new scar. Doesn't seem to have worsened any during the day. I am crossing all my fingers and toes that it heals up right this time.