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Conseils cicatrice près une césarienne.

Scar after a Cesarean section: what to do?

A cesarean delivery is a significant surgical procedure that leaves a mark on the skin. To prevent infection and reduce its appearance, it is essential to care for this scar. What are the steps to take to manage the scar it leaves behind?

Summary
Published February 8, 2024, by Pauline, Head of Scientific Communication — 6 min read

What is a cesarean section?

While the etymology of the word "cesarean" remains a topic of debate, it is known today that the origins of this practice date back to antiquity. However, it's worth noting that, contrary to popular belief, it is highly unlikely that Julius CAESAR was born via cesarean section. At that time, the chances of a mother surviving this procedure were almost nil, and from the writings of some ancient authors, such as Suetonius, we understand that Aurelia COTTA, the mother of Julius CAESAR, lived at least 60 years.

The term "cesarean" refers to a delivery through the abdominal route. This surgical procedure involves delivering the baby from the mother's abdomen through a transverse incision, known as a "Pfannenstiel" incision. It is a more common operation than one might think, as it accounts for approximately 20% of births. A cesarean may have been scheduled in advance when a vaginal delivery presents a risk to the mother or child, or it may be performed as an emergency when the conditions of labor necessitate it to preserve the health of the woman and her baby.

In all instances, a cesarean delivery leaves a scar, both on the uterus and the skin of the abdomen. The process of epidermization of the scar generally begins once the stitches and staples are removed. Before turning white, the scar first turns red, then takes on a pink hue.

Post-Cesarean Scar: How to Promote Healing?

After a cesarean section, the scar is covered with a dressing to protect it. This is generally removed after a few days. The sutures or staples are then removed between 5 and 10 days after the delivery. Subsequently, it is necessary to adopt certain precautions to promote healing.

  • Keep the scar dry for the first three days following the cesarean section.

    It is crucial to keep the cesarean section scar dry after the procedure. This includes refraining from showering. Indeed, the limestone content in the water could potentially irritate the skin, which is already weakened by the surgery, and delay its healing process.

  • Protecting the scar from the sun.
    In the months following a cesarean section, it is crucial to shield the scar from UV rays. Therefore, favor long shirts or jackets that cover the lower abdomen, or place a bandage over your scar. As a last resort, if you must expose yourself, generously apply a broad-spectrum sunscreen. The skin at the site of the scar is indeed thinner and more fragile, allowing more UV rays to penetrate. This increases the risk of hyperpigmentation, meaning the scar could permanently turn a brown color.

  • Avoid smoking.

    Tobacco is the enemy of healing. Indeed, the carbon monoxide contained in cigarettes impairs the ability of the blood circulation to transport oxygen. This element is essential for tissue regeneration. Studies have also shown that nicotine, found in tobacco, has a vasoconstrictor effect and reduces blood flow, thus negatively impacting the distribution of nutrients to cells.

  • Massage the skin.

    To promote healing and stimulate cellular renewal, it is recommended to massage the skin where the procedure took place. However, wait about two weeks for the wound to be fully closed and perform gentle movements. Lightly press on the scar with your index finger and perform circular massages. You can also apply a regenerating cream to stimulate the activity of fibroblasts. Certain vegetable oils rich in omega-6, such as theavocado oil or the rosehip oil possess this property. If the massage is painful, it may mean that your skin is not quite ready yet. In this case, it's better to wait.

Cesarean Scar: Possible Complications.

Generally, the techniques used for performing cesarean sections result in discreet scars. However, complications can occur and cause a infection. It should be noted that this happens in less than 5% of cases. The scar then becomes red and oozes, and it is necessary to perform a new operation as soon as possible.

It can also happen that the post-cesarean scar thickens, becomes hard, and is accompanied by itching. Here, we are talking about a hypertrophic scar. This type of scar is due to an overproduction of collagen in the dermis. The amount of fibrous tissue is so large that it distorts the scar and increases its volume. The hypertrophic scar generally resolves itself over a few months. To optimize its healing, corticosteroid creams may be prescribed.

Conversely, the scar may have edges that sink deeply to form a groove. This is referred to as a scar invaginated. It is more difficult to diminish with creams and often requires a new surgical operation if one wishes to completely remove it.

Sources

  • SILVERSTEIN P. Smoking and wound healing. The American Journal of Medicine (1992).

  • Thèse de Julie PEYRE. La prise en charge à l'officine des cicatrices linéaires post-chirurgicales (2021).

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