Scar Care After Appendectomy

An appendectomy is performed laparoscopically by inserting tools through several small incisions or as an open procedure, resulting in a larger incision. Both methods cause scar tissue to form as the incisions heal. Typically, these scars fade over time with proper care. Scar care treatment can include topical creams or gels, such as cocoa butter, vitamin E, silicone gel, and more.

This article discusses scar care after appendectomy—the usual location of the scar(s), routine scar healing, signs of infection, what scar tissue feels like, and how to treat scar tissue as it forms.

Types of Appendectomy Scars

Appendectomy scars vary based on the procedure used to remove this organ. A laparoscopic appendectomy is a less invasive surgery than an open appendectomy. One 2016 study found that people with a laparoscopic appendectomy experienced shorter hospital stays, required less pain medication, and had a faster return to regular activities.

Location

Healthcare providers make multiple incisions during laparoscopic appendectomy surgery. The location of these incisions varies by the surgeon. Typically they make one small incision near the belly button, inflating your belly with gas to make room for surgical maneuvers. They make two others incisions in the lower abdomen, where they insert a tiny camera and other tools to remove the appendix.

During an open appendectomy, your surgeon makes an incision in the lower right abdomen (the appendix location). Once they remove your appendix, your surgeon closes the incision with stitches or staples. During the healing process, scar tissue forms in each incision.

Size

Laparoscopic incisions are very small—usually less than one-half of an inch. Open appendectomy incisions are typically between 2 and 4 inches.

Normal Healing vs. Infected Incision

After surgery, your incisions go through the healing process. Initially, they will be swollen and tender to the touch and appear darker than your natural skin color. Small amounts of fluid will drain from the incision. This fluid should be clear or have a small amount of blood.

Once the wound closes, the scarred area will remain darker than your natural skin and shiny for several weeks as new tissue grows. It is normal for the scar to itch during this time. Eventually, your scar will fade, which can take up to two years.

After an appendectomy, monitoring your incision(s) for signs of infection is essential. Surgical site infections are relatively rare, occurring around 1% to 3% of the time. However, the effects of surgical site infection can be severe, especially if the infection spreads deeper than the skin. Signs of surgical site infection can include the following:

• Cloudy fluid draining from the incision site
• Fever
• Redness around the incision

An infection can also cause pain in the general area of your surgery. However, this might not be immediately obvious because pain is expected during the first couple weeks after appendectomy.

Scar Tissue Buildup After Appendectomy

Sometimes, excess scar tissue can develop after appendectomy. Abnormal scars can be hypertrophic or keloid.

• Hypertrophic scars are raised but stay within the borders of the original incision. They are often red and thick and start developing within a few weeks of surgery.
• Keloid scars are raised and expand beyond the borders of the original incision. Keloid scars can develop up to one year after surgery.

Excess scar tissue is treatable, but there's no guarantee it will go away. Treatments can include:

• Cryotherapy (freezing the scar off)
• Laser surgery
• Pressure therapy
• Radiation
• Silicone dioxide
• Steroid injections
  

On rare occasions, hypertrophic or keloid scars are surgically removed. However, they frequently grow back—and often end up more prominent than the original scar.

Pain Inside the Scar

Pain is a normal part of the body's reaction to injury, trauma, or other causes, known as the inflammatory response. While it is uncomfortable, pain inside the scar is a normal part of the healing process. However, pain lasting longer than three months that does not improve is considered chronic and signals that you should follow up with your healthcare provider.

Itching

Similar to pain, itching is expected during the healing process. It can last up to six months and typically signals that you are experiencing the remodeling phase of wound healing when your body builds scar tissue and a new outer layer of skin.

When to Start Scar Massage

Once the incision has closed, you can begin scar massage. Using cocoa butter, vitamin E, or a similar product, massage your scar for 10 minutes twice daily. Use firm pressure—but not so much that it causes pain.

Scar tissue forms long after your incision has healed, so keep up the scar massage. Scar tissue will become softer and lighten in color around two to three months after surgery.

Scar Visibility Fades With Time

Taking proper care of your incision after appendectomy can help minimize complications with scar tissue. Follow your surgeon's specific instructions after surgery.

Incision management tips include:

• Keep it clean: Bacteria can enter an incision and lead to infection. Wash the area with gentle soap and water, and pat dry before applying a sterile dressing.
• Change the dressing: Change your dressing daily or more frequently if your incision is draining.
• Adjust your activity: Follow your surgeon's instructions regarding carrying and lifting; extra stress on your healing incision and cause it to re-open.

Summary

Scar tissue formation is a normal part of healing after appendectomy. Over time, scars typically become flatter and lighten in color. In some cases, excess scar tissue forms, leading to hypertrophic or keloid scars. Scar management begins with proper wound care while your incision is healing, followed by scar massage for several months.