Keloid scarring

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Peter Easton

I am preparing for AVR in early September, and not the "minimally invasive" kind. I gather the incision is a slice "from the guggle to the zatch," as a character in Thurber's "Thirteen Clocks" once put it: i.e. from just below the Adam's apple to the lower sternum. My question has to do with the scar, its persistence and management of it. I have Keloid scarring, which is (in my experience) a raised, shiny and somewhat enlarged type of tissue over the scar -- most characteristic of African descent (a point of pride which reminds me that integration worked pretty well after sundown starting centuries ago!) but also present in some others, I guess. Do any folks have experience with Keloid scar formation over the incision site? What's to be expected there?

Thanks,

Peter
 
You will get more answers, but I believe they just cut out the keloid scarring when they make the new incision. The question about a previous scar came up recently and others responded that they go in at the same point that's already scarred. And yep, the "cut" is from the beginning of bone at the top of the chest right on through the ribs. Eventually you will be proud of that scar because of its meaning. God bless
 
Clarification

Clarification

Thanks, but I evidently wasn't clear with my question. It concerned the scar from this operative procedure, not any existing scar. In my experience, keloid scars can be pretty bulky and inflexible and don't tend to fade or disappear with time -- or only VERY slowly. I have one from a skin cancer removal that is twice the size of teh incision and still quite prominent. So I am trying to imagine what that adds up to when the incision is the long swath of "invasive" AVR.

Peter
 
Hi Peter,

I have the very problem you are speaking of. Only seven months since my surgery. The cardio keeps saying it will fade in time. However, I don't think this is so. I like janie's idea if it's possible. My incesion is relitivley short,told the surgeon I wanted to wear my dresses with out showing a scar. Both my mother and sister have keloids. I have been putting vitimin E oil on it seems to help a little.
 
Last edited:
Peter

The top of my scar was raised. My dermatologist injected the raised part with cortisone and the one shot broke up the scar tissue. Quick and painless...it may require more than one shot. Good luck.

Jim
 
Good ideas

Good ideas

Thanks for the suggestions. I'll especially remember to see about a plastic surgeon taking part. I did have my existing keloid scar from the skin cancer injected with cortisone -- in my case, something less than a perfectly painless procedure -- but it seems to have had zippo effect.
 
There are several tecqniques for minimizing scarring from an incision. There is more than one way to close a wound. Discuss this with your surgeon befoe the operation. I had a AVR in 1988 and they used clamps on my chest. I have a flat line, 1/8th to 1/4 wide down my chest. It is not very noticeable except it is a slightly lighter color. I am not prone to developing keloids but my wife is very prone. When she gets a cut, she keeps the area moist and covers it with tape, not letting it dry out. This seems to work for her, but may not be practical in your case.
 
Keloid Scarring

Keloid Scarring

I have Keloid scarring as well. It is still itchy and tight. My surgery was over 14 months ago, and this scar keloid still drives me crazy as well as being very ugly. I told the doctors about the scar problem. They ignored me and told me it was because my chest was healing. I finally got a referral to a dermalogist. He told me they should have sent me to him months ago. Now I have to go to a plastic surgeon and have the area cut down. Then the dermalogist can inject the area with steroids to reduce its size.
 
A sister under the skin

A sister under the skin

Thanks, Doris -- that's just as I suspected, from my own experience with previous scars, but it sure helops to be "forewarned" from your account. Will see what I can do. My skin cancer scar is likewise unsightly and tends to itch (then hurt when scratched), so I was suspecting that something more might be in store after "sternotomy." There's always a bit more to the story than one suspects!

Peter
 
Hello Peter,

I had two AVR replacement surgeries within 11 days 8/2000. First surgery my scar was neat, and looked like a 9 " cat scratch. Second surgery eleven days later I developed a horrid keloid scar, which has been very painful to say the least. I went to see the surgeon last February to complain about something pricking me in my skin. I thought one of the wires had come loose. He told me it was the keloid scar and that they can be quite painful and itchy at times. He refused to open me up again and take a look.
I also was told that whatever cosmetic surgery I would have the scar might get worse. That all surgery is still surgery.
My scar feels better today almost one year post-op, but does not look better and there still is discomfort at times.
At this point I don't think I am going to do anything about it. Like Ben Smith told me at the reunion in Scottsdale, he thinks of it as his "badge of honor".
I am trying to think of it as he does. Not easy, as I don't really like wearing lower cut blouses or sweaters anymore.

Christina
Mechanical St. Jude's/ 8/2000
Coumadin
 
Keloid

Keloid

Peter,
I too have the Keloid scaring.
My cardio, at my three month check-up, told me to expect the scar to be rather unsightfull.
Well, he was half right. It is pretty big. Although it doesn't bother me like I thought it would.
I tried alot of the remedies that my heart buddies here suggested, as far as lotions or creames and things to put on it to keep it small.
Didn't work. I agree with one comment above, "being proud of it". I am very proud of it. Without that scar I would not be here to spend this time with my family and friends.

God Bless;)
 
Shiny badge of courage

Shiny badge of courage

Thanks, Ben --

Good to get your experience and I certainly add an "Amen" to your gratitude for renewed health.

I'm not much concerned about the looks, but have found an existing (small) keloid scar to be itchy, binding, sometimes painful and uncomfortable. When I mentally multiply that by the size of the AVR incision, I blanche a bit. But we may just have to swing with it and consider it a small price to pay.

AS related over on the thread about "making the choice," I posed the question yesterday to my prospective surgeon and asked about some of the remedies folks had suggested, including participation of a plastic surgeon or dermatologist on the surgical team. He said he does take some precautions to help minimize keloid scarring, but didn't think the plastic surgeon or dermatologist adds enough payoff to compensate the increased complexity of the opeartion with that many cooks laboring over the broth.

Peter
 
PS t previous

PS t previous

Talked to my dermatologist today -- or rather the nurse. She said to ask the surgeon to inject cortisone during the operative procedure - and that they could do the same on different occasions once I was "convalesced." Apparently the dermatologist's office does this as a virtual monthly routine for patients with persisent keloid scarring, and the effect over time is to reduce or eliminate the problem, though it may crop up again later. (Not a joyful prospect. I'll admit that I only had it done once for my skin cancer scar, then let it go as there was a little effect, the shot itself was unpleasant and it all cost something. But I may need to go back down this route after surgery, I suppose).

She did say that keloid scarring tends to pose more of a problem on sites that get a lot of abrasion and torque -- like (or near) joints -- and may be less evident on the sternum. My skin cancer scar, it's true, is right on the hinge between shoulder and upper arm.

Peter
 
Keloid Scarring

Keloid Scarring

I am surprised at the concern for scars and scarring versus scar tissue. I had 7 surgeries on my feet years ago and to this day have trouble with scar tissue. The scarring bonds to the closest muscle or tissue around it and impedes movement. This includes trouble upon moving, stretching, reaching, etc. along with hypersensitivity to the area.

I was always told to massage the area thoroughly during the entire healing process to prevent scars from adhering. It is not easy to do when the area is sensitive and painful.

Has scar tissue been a problem with anyone else? Suggestions? My next questions is what to do with the low cut holiday evening gowns hanging in the closet. Sounds like they, too, will be bygones.......

Deb
 
Tissue

Tissue

Hi Deb --

Unless I misunderstand the words, my concern with Keloid scarring is with scar tissue and with just the kind of issues you mention. In my experience, the Keloid tissue is inflexible, bulky, itchy and pretty hard to manage.

Peter
 
Keloid Scarring

Keloid Scarring

Hi Deb,

I think I will have to give all the low cut shirts I own away. For a Christmas Party I wore a black sheer type cover up over my velvet camisole top. Before the surgery I would have left the buttons open on the coverup. No one other than the friend who took me to the party knew I had a scar. I'm planning to have a couple of shirts altered by a friend who sews. This winter I plan to put a light weight tee shirt under my V-neck sweaters. I hope this helps.

Doris
St. Jude's Mitro Valve
April 6, 2000
 
Horizontal Scar!

Horizontal Scar!

I've posted this before, but I want to remind everyone that there is another option. My scar is horizontal, just under my breasts where the underwires go. It kind of scallops up in the middle and looks like a kid drawing of two waves. The surgeon needs a large, gaping hole in order to crack the chest and open the ribs. A horizontal cut through the skin accomplishes this as well as the vertical cut. The only way anyone would see my scar (other than if I was naked or topless) is if I wore a deeply plunging neckline (the Cher variety) or perhaps a bikini.

I do have a little keloiding in the middle of the scallop, but after 3 years, it has gotten much better. Just a few small bumps.

If someone really knows what they are looking at, they might notice a bump at the top of my sternum, but that has gotten better as well.
 
Just to give my experience - I had my operation in May 2009 and developed Keloid scarring. My GP gave me something called Haelan Tape which is just a strip that you apply to the scar and it slowly releases steroid(I think that's what it releases) on to the scar. I've been using it for a week and already seen a reduction in the size of the scar! I'd definitely recommend it. Hopefully it will get rid of the whole thing soon
 
My scar is keloid for about 3 inches below my sternum. The rest is raised and ropey, but better than the itchy and sensitive tissue on the lower part. I took a long time healing but the nurses that helped with my dressings and wound management used the type of compression bandage (epithelial coated dressing next to the open wound) that is used on deep burns. It's expensive but did hasten the healing although the itch and sore burn I felt lasted for nearly a year and a half. It's markedly better now unless I'm really warm and my bra irritates it.
 
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