Scabs After Surgery

How To Care For a Surgical Incision With Scabs

Scar on knee after surgery
Jan Hakan Dahlstrom/Photographer's Choice/Getty Images

If you have recently had surgery, the appearance of your incision may be a topic of great concern for you. Trying to determine what is normal, what is abnormal and what should be done for the best possible incision care can be very challenging.  Scabbing, in particular, is often an area of concern during the recovery phase of healing, and leads to many patient questions.  

A scab is a normal occurrence when your skin has been damaged, and it should be left alone.

Whether you have skinned your knee or had major surgery, the formation of a scab is part of the healing process. The scab typically covers the damaged skin underneath and forms a protective covering while the underlying skin continues to heal.  

Your skin has a remarkable ability to heal itself, using blood that moves to the site of injury to first stop any bleeding that may be present, then to seal the area so that healing may begin. A scab also works to protect the area, creating a harder “shell” at the site.  Damaging the scab will slow healing, so it should be left alone to fall off on its own, if possible.

What Makes a Scab?

A scab is formed when parts of your blood work to stop the bleeding that happens at the site of an injury.   Bleeding sends platelets--the part of the blood that forms clots at the site of an injury--and fibrin, a fiber-like protein, to the damaged area of skin.  There, the platelets and fibrin work together to “seal” the injury, stopping any bleeding and forming a scab.

 

This process is absolutely essential to life.  Without platelets and fibrin, we would bleed profusely from the smallest injuries, and eventually die from blood loss from something as small as a skinned knee. 

Incisions, Skin Care and Scabs

It is completely normal for your incision to have a scab. This is a good indication that your incision is healing, as a scab is an early part of the process that fills in the incision with new skin and tissue, closing the wound.

If pus is oozing from your incision, alert your surgeon. But you don't need to be alarmed about a scab.

It is important to not “pick” at your scab. It is equally important that you do not scrub at your scab during your shower.

Removing the scab intentionally can increase scarring and slow healing. This is true even if the scab is forming around your stitches and making them appear discolored or dirty. Wash the area gently during your shower with the same amount of soap you would use on an area of your body that does not have a scab. Rinsing well is essential, as soap may irritate the wound.

When Will Your Scab Fall Off?

A scab may remain present for a few weeks, and it will gradually fall off with normal activity. Do not be alarmed if small pieces of the scab remain while other pieces fall off. Your incision may heal more quickly in some areas than others, especially if it is in an area where movement may place greater stress on small portions of the incision.

A shower or bath may soften a scab and could make it fall off. This is not a problem as long as you don't scrub the scab off your incision. It is also normal for the skin underneath the scab to be more sensitive than the rest of your skin as well as pale or pink.

When is an Incision Healed?

An incision is "closed" when it has completely closed and there are no gaps between the two areas of skin that were sewn together but that does not mean it has fully healed.  The scabs will have fallen off at this stage, and the skin may be pale or pink, but at this point will no longer be an infection risk. While the skin has closed completely, the incision isn't truly fully healed because there is a difference between the skin closing completely and the tissues beneath completely healing.

An incision can take six months or even a year to reach maximum strength and healing, depending on the type of surgical incision.

 This is because a surgical incision, like an iceberg, is often much deeper than it appears and several layers of muscle and tissue beneath the skin may also be healing.  These deeper layers take longer to heal, and an incision in a major muscle group that is very active, such as the abdominal muscles, could take more than six months to reach full strength.

More About Proper Incision Care

Sources:

Chemical Peels. DermNet NZ http://dermnetnz.org/procedures/peels.html

A Patient's Guide to Lung Surgery-Taking Care of Your Incisions After Lung Surgery http://www.cts.usc.edu/lpg-takingcareofincisionsafterlungsurgery.html

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