During a caesarean section, not only the skin on the abdomen is cut, but also the entire abdominal integuments and the uterus. A scar visible on the skin is therefore, colloquially speaking, “the tip of the iceberg”.
During the formation of the scar, the wound fills in over days and weeks, with successive layers of collagen. Under normal conditions, the scar becomes paler during this time, less protruding above the surface of the healthy skin, fading over time and eventually taking on a pearly layer. The volume of collagen also decreases slightly, so that the scar becomes thinner. The speed of healing and the nature of the scar produced depend to a large extent on the smoothness of the wound edges, the precise approximation of them to each other with the simultaneous filling of a good blood supply to the wound, as well as on individual characteristics.
We can divide the healing of a surgical wound and the formation of a scar into three stages:
- Stage I – the inflammatory phase. Lasts from 2 to 5 days after surgery. In this phase, the inflammatory reaction is triggered, mainly involving macrophages that secrete cytokines and growth factors.
- Stage II – proliferation and angiogenesis phase. Lasts up to 6-8 weeks after surgery. In this phase, the migration of fibroblasts and macrophages to repair the wound site occurs.
- Stage III – modelling/reconstruction phase. Lasts until approximately 1.5-2 years after surgery. During this phase, scar remodelling occurs, which is associated with a change in the orientation of collagen fibres and shrinking of the scar. During this stage, features such as the appearance, thickness and functionality of the scar are finally defined.
The therapy of a caesarean section scar will depend on what stage the scar is at.
Antonina Kaczorowska
References:
- Chochołowska M. Praca z blizną po operacji cesarskiego cięcia. Rehabilitacja w praktyce 2018; 5: 36-42.
- Drozd A, Nowacka-Kłos M, Szamotulska J, Hansdorfer-Korzon R. Możliwości zastosowania terapii manualnej w obszarze blizny. Rehabilitacja w praktyce 2021; 4: 34-42.
- Kasprzak W, Mańkowska A. Fizjoterapia w kosmetologii i medycynie estetycznej. Wydawnictwo Lekarskie PZWL, Warszawa 2012.
- Marciniak M. Mobisation of the scar after cesarean sction. Praktyczna Fizjoterapia i Rehabilitacja 2021; 131: 8-16.
