In no way is it false modesty to say that physicians are not healers. At best, what we do is to grease the way, to make conditions as favorable as possible for the body to heal itself. For without the body's amazing powers of defense and repair, nothing we do -- especially we surgeons -- would be lasting at all. The most immediate and palpable reminder of this is the process of sewing someone up, and watching what happens.
Wound healing is a wonderfully complex process, and it would be folly for me to attempt explanation in detail; mainly, because I've forgotten the pathways, the kinins and the prostaglandins involved. I'm not going to look it up again, but you can if you like. Anyone who's had an operation, from minor to a big deal, has had the opportunity to witness it. Maybe you were too sore to be in awe. But I always liked to point out the easy evidence to my patients.
I've gotten calls about red incisions (despite trying to explain it in advance.) Of course, it's necessary to separate the natural from the infected (digital photography and email have been known to save an office visit, for the technologically inclined); but all incisions get red for at least a few millimeters out from the cut. An inflammatory response, it's the process of bringing the building materials into the work site: capillaries dilate and proliferate, blood flow increases. That, and much more, goes on under the surface as well. Attracted by "injury chemicals," various cell types arrive and unload their cargo, set up lattice work, induce structural changes. The result of the influx is a gradual thickening and hardening of the area for an inch wide or more, and which carries the unofficial-official name "healing ridge." When the ridge isn't there, you know there's trouble ahead. In the very ill, in people on high-dose steroids, in the malnourished, a soft and non-pink incision is an unwelcome and unhappy harbinger.
As much as feeling the healing ridge can alarm the unexpecting, it's a sign of health, the indication that help is on the way, that work is going on to effect healing. I'd warn people. To hernia patients, I'd say, "In a few days it's going to feel like a sausage under there. You might think the hernia is back." Or, after removing a lump of some kind from some place, "In three weeks, you'll think I didn't remove it at all." It takes many weeks for the ridge to melt away. The zone of redness dims, but the incision itself gets increasingly red, and doesn't simmer down for a year or more. (It also fades after the application of vitamin E, of ear wax, and of snake-oil, singly or in combination.) It's a living monitor of how long healing is active. Given an explanation of what's going on, surgipatients get a ridge-id ringside seat from which to watch the body do its work. (A corollary is the tiredness that most everyone feels after surgery. There's lots of work going on, I'd tell them. While you're lying around feeling lazy, your body is doing the equivalent of walking around all day. Give yourself a break.)
218 comments:
«Oldest ‹Older 201 – 218 of 218Thank you Doctor for this wonderful explanation of the post open appearance of the scar. So far, the best and most professional and simple in general terms!
I hate to speculate about something I can't examine. If you have concerns, it's best to have your surgeon look at it. Sorry.
I will join the club and say a big THANK YOU for the healing ridge info! As someone mentioned before this info should be given in print when you leave recovery. I am three weeks post op after femoral hernia repair (without mesh) and thought maybe it had recurred already! I felt the hard lumpy area around the incision and didn't know what may be until I ran into your post. Extremly useful and calming
Hi, not sure if this is still active but had a bowel resection 6 months ago electively. Noticed a hard lump area after a few weeks from surgery. My incision is 3 inch lateral on the pubic mound and done laproscopically. The bulge is firm but goes flat when laying down a while. Ultrasound and cat scan doesn't show anything hernia-wise. My abdominal surgeon has an excellent reputation and many years experience. He says the area is a healing ridge which was only mentioned now. It does rise when I cough and I experience at times gurgling there but I also will feel that sensation other areas of the pubic region ,which he says is normal. I understand that female hernias are difficult to visualize on studies. I did tell him approximately 2 months post op I felt a painless pop in the general area and that was explained as an internal incision may have opened. He said it takes 6 months for internal sutures to absorb. Thankfully my bowel movements are good and don't have any trouble with the resection itself. Someone told me this may be a hernia that didn't come through all the way yet. The cat scan I had was with oral contrast. But how could it be visualized if you are laying down and everything flattens? I've experienced some itchiness last month but now replaced with achiness and some burning. I know there isn't much you can say since you cannot physically assess the situation. I do have a history of two C sections and an abdominalplasty. The area is very firm and its 6 months now. Can you comment?
Sorry for the delay. I just discovered I haven't been getting comment notifications. Hope you'll see this.
Six months is long for a healing ridge to persist, but not impossible I suppose. What you describe sounds a lot like a hernia but, as you say, it's impossible to assess without being able to examine. My opinion is that CAT scan isn't great for diagnosing hernias; maybe repeating the ultrasound in a while, if it persists, would be a good idea. As would following up with your surgeon. If you have another ultrasound, it should be done with you relaxing and with straining maneuvers.
Great blog. I am about 5.5 weeks out from an umbilical hernia repair. My incision was inside my belly button at the top and has healed very well, howevever my issue is this ridge/hardness. Surgeon said it was the healing fascia and that it "should" resolve. I feel like it is pushing the top of my belly button out. Should that ridge flatten out and this sink back in?
I can't evaluate your particular situation, of course. All I can say is that, as I wrote, the healing ridge can take three months or more fully to resolve. You're not halfway to that point, so...
Thanks Doctor. This really helped me out. I'm ten months post surgery and it seems my ridge is almost gone. I'm assuming this is normal as I have no pain. Lately though, it seems to feel like its twitching. Could this be nerves reattaching? Also feels like some tugging and light pinches. I am planning on seeing the surgeon just to be safe, but was wondering your opinion prior. As most here said, I was also not notified of the healing ridge. Thanks. MJ
Hard to say, of course. And you didn't specify what operation you had. In context of the post, I surmise a hernia. In any case, nerves can take a long time to heal, and when they do there can be various sensations. So, maybe that's it. I don't know what to make of "twitching." Hopefully you'll get more accurate and meaningful input when you see your surgeon.
Sorry Doctor, Right Inguinal Open with mesh and plug.
Thanks for this post. I had an inguinal hernia repair last Friday so a week ago. They really did a number on me and I have extensive bruising everywhere including on my back. Since Wednesday I’ve notice what seems like a rolled sausage beneath my skin, soft around it but quite hard to touch. It sits just below the scar. Is this a healing ridge?
It's a little early for a healing ridge to be forming. Could be swelling from surgery or a hematoma, meaning a collection of blood in the wound. There's no way to know without examining the area, so it's best to be in touch with your surgeon.
Thanks Doctor, perhaps it’s the mesh and the abdomen wall fusing together. I just hope that it isn’t a recurrence of the hernia
Thank you for the blog. I'm four weeks post paraumbilical hernia surgery done without mesh... It was small, the surgeon said , 1 cm defect... I seem to have developed healing ridge in the third week and was alarmed..... The surgeon did not mention any of it. It is red and tender and i really thought i had a botched up surgery. Reading it blog has given me assurance.
A relief to read this and know that others have worried that their surgery didn't take; your post was reassuring. I'm a week out of inguinal hernia repair, and couldn't imagine why things weren't perfect. A good reminder that healing takes time. Thank you. Wish surgeons were more communicative about post-op.
Thanks! Glad it's still helpful.
Woow, such a great post written so many years ago but current and valid as of today! The best post I have found about post -surgical healing.
I had 14 days ago laparoscopic bilateral inguinal hernia repair, with a mesh that was put in both sides. Everything went great except that on my right inguinal side but NOT on the laparoscopic incision a lump has appeared, with a little pain when hand pressing.
No fever, no redness in the area, no hematomas. Actually I have a consultation appointment with my doctors today...
Nevertheless, the question I have is: Are "healing ridges" also formed internally where the laparoscopic dissections were made to clean the actual hernia defects and then put the meshes in place? The mesh's locations are far (relatively speaking of course) from the laparoscopic incisions/ports where small healing ridges are certainly formed and can be seen and felt. I'm interested in finding out if the lump could be part of an "internal healing ridge(s)" which could potentially even include a seroma.
This will be discussed with my surgeon today, but I'd most appreciate your comments on this issue.
Thanks in advance and congratulations for this phenomenal post.
Kind regards from Mexico City.
The healing process goes on wherever there's been surgical injury. So, yes, the lump could be normal healing. But the best thing is what you've said you plan to do: discuss it with the surgeon.
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