Surgery plays a crucial role in many patients’ cancer treatment plans. Regardless of the type of procedure someone undergoes, most surgeries leave a wound that takes time to heal and then scar over. One of the first questions many patients ask is how long a surgical wound will take to heal and how quickly a scar will form.
“Wound healing takes place over four different stages,” explains Antoine Lyonel Carré, M.D., M.P.H., a plastic surgeon at City of Hope® Cancer Center Duarte and an expert in the pathophysiology of wound care and healing. “But the key thing is that there is the healing of the wound and the maturation of a scar, which are two different things.”
In this article, Dr. Carré explains how wounds repair themselves across these four stages and offers recommendations on issues patients should look out for during the healing process, addressing topics such as:
- Why do scars form?
- How long does it take for a surgical incision to heal?
- Scar healing stages
- What if your scar isn’t healing?
- Hypertrophic and keloid scars
If you or a loved one has been diagnosed with cancer or would like a second opinion on a recent diagnosis, call us 24/7 at 877-834-8941.
Why Do Scars Form?
The wound healing process involves many different types of cells in the body. The formation of a scar is the final stage of wound healing.
During this stage, cells in the body called fibroblasts travel to the site of the wound, where they lay down a layer of a protein called collagen.
“That's when the body forms the new tissue that creates the scar,” Dr. Carré says. “This usually starts around the third day after surgery and continues for up to 30 days. This is called the proliferative phase.”
The next phase, the remodeling phase, takes place nine months to 12 months later, during which the collagen continues to remodel itself so the scar tissue gains strength.
How Long Does It Take for a Surgical Incision to Heal?
“A surgical wound usually takes about six weeks to achieve 50% of its final strength and about eight to 10 weeks to get to 80% of its final strength,” Dr. Carré says, adding that a fully healed wound which takes about a year and never achieves more than 80% to 90% of its initial tensile strength.
After a wound has healed, it can take nine to 12 months for the scar to complete its remodeling and fully mature.
“That’s why the earliest a patient can get a revision done for a scar they may not like is around nine to 12 months,” he says.
These timeframes are not entirely set in stone, however. Some patients take longer to heal, while others may heal more quickly, depending on a variety of factors, including:
- The patient’s age
- Any other existing health issues, such as diabetes peripheral vascular disease or heart disease
- Recent chemotherapy treatments
- Any history of receiving radiation therapy
- Any other medications, such as steroids
While there is some variation in how long it can take for an incision to heal and scar, “the healing phases always happen in the same order, and the only thing that changes is the duration of each stage,” says Dr. Carré.
Scar Healing Stages
There are four stages of wound healing: hemostasis, inflammation, proliferation and remodeling (also called scar maturation).
“The first phase happens within minutes to hours, then the second phase lasts from one to two days,” Dr. Carré explains. “The third phase starts at three days and lasts up to about 30 days, and then remodeling starts at about four weeks and takes up to nine to 12 months.”
Below, Dr. Carré shares more details on the stages that each wound progresses through.
Hemostasis
Hemostasis is the process the body uses to stop a wound or incision from bleeding. It usually takes place over the first 24 hours after the wound is made.
“During hemostasis, your body releases what we call cytokines, which are cells that tell the blood vessels to constrict and stop the bleeding,” says Dr. Carré. After that, a type of blood cell called platelets travels to the site of the wound and creates a “plug” that blocks the wound.
Inflammation
“Inflammation brings cells that help you heal,” Dr. Carré says.
These cells, called neutrophils and macrophages, are types of white blood cells. They help remove bacteria and other substances that could cause an infection, but they also set the stage for the body to build new tissue to repair the wound.
Inflammation usually takes place over the first few days after a surgical wound was made and can last up to two weeks. During this phase, macrophage cells start to “call in” another type of cell to begin the next stage of healing.
Proliferation
During the proliferation stage, another type of cell called fibroblasts travel to the site of the wound. Fibroblasts are central to repairing tissue in the body.
“Those fibroblasts start laying collagen down,” says Dr. Carré. “As your body releases this collagen, it begins to form new tissue that creates the scar.”
This process starts at around four days and can last up to 30 days or longer.
Remodeling
Remodeling, sometimes also called maturation, is the final healing stage a wound goes through before it becomes a scar.
“From the end of the third stage, which is about a month and a half out, all the way to nine to 12 months, the collagen continues to remodel itself so the new tissue gains strength,” Dr. Carré says.
During this time, the new scar tissue becomes stronger and more flexible. It may also begin to look more like the tissue around it, though in most cases, a scar will not fade entirely.
What If Your Scar Isn’t Healing?
Some complications may prevent a wound or scar from healing properly. The most common is infection.
“If you notice redness, increased pain, swelling or fluid emanating from the incision, your wound is most likely infected,” Dr. Carré says, adding that the fluid doesn’t have to be foul-smelling or pus-like for it to indicate that a wound or incision is infected.
Other possible issues include:
- A wound coming open (also called dehiscence), which can occur if surgical sutures dissolve while the wound is still in the early proliferation stage of healing
- A seroma, which is a build-up of fluid underneath the incision that can force the wound open again during the early healing process
- Necrosis, which is a condition where cells die and turn black, caused by poor blood flow to the wound area, among people with conditions like diabetes or peripheral vascular disease, which affect the vascular system
- Radiated tissue, which leads to decreased blood flow
- Systemic factors (i.e., steroid use, obesity, smoking, edema, malnutrition)
- A foreign body in the wound
If a patient or caregiver notices any signs that a surgical wound is not healing properly, they should make an appointment to see their cancer care team or surgeon as soon as possible.
What Factors Can Cause Wounds to Heal Poorly?
“There are many medical conditions and issues that can affect how a scar looks, independent of what a physician does during a procedure,” says Dr. Carré.
In addition to the possible complications mentioned above, such as infection or a wound reopening, some other factors may play a role in how effectively the body can heal a wound, including those listed below.
Sex and age: Men and postmenopausal women tend to heal less quickly than premenopausal women.
Smoking and alcohol use: Using tobacco or drinking too much alcohol can reduce the flow of blood and oxygen throughout the body, making wounds take longer to heal.
Compromised immune system or steroid: People with inflammatory diseases, those who have undergone chemotherapy, recently completed a course of chemotherapy, were treated with a high-dose steroid or have immunodeficiency disorders like HIV heal less quickly.
Hypertrophic and Keloid Scars
Most wounds heal and form scar tissue normally. However, two types of scar may develop abnormally: a hypertrophic scar and a keloid scar.
“If someone closes a wound under high tension, you end up with a raised scar called a hypertrophic scar,” Dr. Carré says. “A hypertrophic scar is usually a technical problem, meaning that the wound was closed with tissue that was too tight.”
A keloid scar is the result of a genetic problem with the body’s cells.
“In the case of keloid scars, there's a dysregulation of the fibroblast cells, which makes the proliferative stage last longer than it's supposed to,” Dr. Carré says. “This causes the body to lay down too much collagen, which gives the scar a cauliflower shape, and the scar tends to extend beyond the margin of the initial scar, whereas hypertrophic scars do not.”
Groups with a higher risk of developing a keloid scar include people with Asian, African or African descent or Middle Eastern heritage or ethnicity.
There are some easy ways to differentiate between hypertrophic and keloid scars.
“A hypertrophic scar tends to remain within the bounds of the original incision, whereas a keloid scar goes beyond the size of the original wound,” Dr. Carré explains. “A hypertrophic scar could be cured or ameliorated with surgical techniques, while a keloid can only be controlled with surgery and other non-surgical treatments.”
If you or a loved one have been diagnosed with cancer or would like a second opinion on a recent diagnosis, call us 24/7 at 877-834-8941.