Any surgery that involves cutting or damaging tissue will leave a scar. This may be a small scar following knee arthroscopy or a larger scar after abdominal surgery. A scar is a natural part of the healing process. The body works to close the wound and restore the strength of the damaged tissue. However, newly formed scar tissue is not identical to the original tissue. The collagen fibres are initially less organised, making the scar less strong and less flexible. Over time, the scar undergoes a process of remodelling and its mechanical properties gradually improve. This process takes months and can continue for more than a year. Caring for a scar therefore does not stop once the wound has closed.
How Does a Scar Heal?
Scar healing takes place in several overlapping stages.
First, bleeding is stopped. Platelets form a blood clot and release substances that trigger the next stages of healing. This is followed by the inflammatory phase. Immune cells move into the injured area, where they remove damaged cells and prepare the tissue for repair. Mild redness, swelling and tenderness can therefore be a normal part of healing during the first few days. Next comes the formation of new tissue. Fibroblasts become active and produce collagen and other components of connective tissue. At this stage, a new but still immature scar is formed. Finally, the scar enters the remodelling phase. Collagen fibres gradually reorganise and strengthen in response to the mechanical forces placed on the tissue. The scar usually becomes flatter, softer and paler over time.
This final phase takes the longest and can continue for several months. Physiotherapy can play an important role during this stage by helping restore the mobility of the scar and the surrounding tissues.
A Scar Is More Than What You See on the Skin
After deeper surgery, it is not only the skin that has to heal. The underlying tissues, including the subcutaneous tissue, fascia, muscles and other structures, also undergo healing.
Under normal circumstances, these tissue layers glide over one another as we move. After surgery, scar tissue can form between them and restrict this movement. This may lead to a feeling of tightness, pulling or restricted movement. When we work with a scar, we therefore look at more than its appearance. We are also interested in how freely it moves and how it interacts with the surrounding tissues.
How Should You Work with a Scar?
Scar care should be adapted to the stage of healing and the type of surgery.
The First Few Days After Surgery
During the first few days, the wound is usually covered with a sterile dressing. A fresh surgical wound should not be massaged or subjected to mechanical mobilisation. Depending on the type of surgery, very gentle work can be performed on the surrounding tissues. Lightly moving the skin and subcutaneous tissue can help reduce tension around the surgical wound. If appropriate, gentle pressure may also be applied over the wound through the sterile dressing. This should always be adapted to the type of surgery and the condition of the wound.
After the Stitches Have Been Removed
Once the wound has fully closed and is healing well, we can begin to work directly with the scar.
We initially use gentle side-to-side movements and small shifts of the scar relative to the surrounding skin. Gradually, different directions of movement can be introduced, including gentle C-shaped or S-shaped movements. The aim is not to forcefully “break up” the scar. Instead, the goal is to restore its mobility and allow the different tissue layers to move more freely against one another. Once the wound is fully closed, the scar can also be moisturised regularly with an unscented moisturiser, petroleum jelly or another well-tolerated product. Keeping the skin supple can reduce dryness and make scar mobilisation more comfortable.
Around Six Weeks After Surgery
If the wound is healing well, more intensive work with the scar and surrounding tissues can gradually be introduced. We can begin working along the length of the scar and gradually increase the range of movement of the scar relative to the surrounding tissue.
At this stage, the scar can generally tolerate greater mechanical loading, but the intensity of treatment should always reflect the type of surgery and the condition of the healing tissue.
Six weeks is only a general guideline. A small skin incision heals differently from extensive abdominal surgery or ligament reconstruction of the knee.
Around Three Months After Surgery
Later in the healing process, additional techniques may be used depending on the individual scar.
These may include silicone cups, silicone scar sheets, kinesiology taping and more intensive mobilisation of the surrounding tissues. Not every scar requires these techniques. Their use depends on the appearance, mobility and sensitivity of the scar, as well as the type of surgery.
General Advice
Protect your scar from the sun. New scars are more sensitive to UV radiation and can become darker with sun exposure. Protect your scar from direct sunlight, particularly during the first months after surgery. Covering the scar with clothing is the most effective option. If the scar cannot be covered, use a high SPF sunscreen. Do not massage or mobilise a scar if the wound is bleeding, is producing pus or unusual discharge, is becoming increasingly swollen, is increasingly red or warm, is opening or separating, or is becoming more painful.