Why do ortho patients workout right after surgery where plastic surgery patients do not?
Stress on wounds helps makes the scar stronger. We know that wounds in space where there is no gravity do not heal as strongly. It is thought stress stimulates growth factors and new blood vessel formation, which helps increase tensile strength of the wound. Mechanical stress may accelerate the gain in tensile strength.
We know the tensile strength of wounds is weak for the first three weeks after surgery and then gains strength, with most strength at 6 weeks, and then full strength at about 3 months.
But does moving and stressing the wound help make the scar stronger or does it break it up and cause the wound to break open?
Again, in orthopedics, when they have major surgery they are up and moving quickly. The orthopedic literature shows early postoperative movement in a controlled manner helps strengthen the wounds and do not lead to more wound healing complications.
Could incision directed exercises in plastic surgery (in addition to simple walking) help certain wound types and accelerate the strength of the scar?
In plastic surgery cases it is not common for scars to come apart. But when you have stress on a scar, the more likely thing you would see is a bad scar. Many studies show there is a relationship between stress on the scar and bad scar formation- hypertrophic scars, widened scars, keloid scars. This theory is supported by common bad scars in areas of the most movement like the knee, shoulder, and chest. When you minimize movement in these areas during healing, the scars are prettier.
Many studies have shown that mechanical forces on wounds and scars, particularly cyclical force, causes an more growth factors to release, which causes the hypertrophic and keloid scars. So if we have early movement do we increase the tensile strength of the scar but make it ugly?
Other studies though have showed reduced scars when there is CONTROLLED mechanical stress.
My thoughts?
- As with many things, there are likely pros and cons. If movement makes the scar stronger, how much stronger? Is there a particular kind of movement that is okay and one (rotational?) that is not? What is the best timing? And what does this do to the visible scar which you will see daily forevermore?