Re: Question for Dr. Li about scarring
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Re: Question for Dr. Li about scarring

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Posted by sleepsurgeon on March 08, 2009 at 10:41:41:

In Reply to: Re: Question for Dr. Li about scarring posted by Captin Cannuck on March 07, 2009 at 12:54:50:

I don't think it is worthwhile to go into the wound healing process, keloid formation or hypertrophic scar formation. However, I would like to explain that mucosa or pharyngeal tissue certainly scars just like other soft tissues. High heat is going to lead to a great amount of tissue injury as compared to less heat or scalpel. Small amount of scarring is actually a good thing, in my opinion. It stiffens the pharynx and limits the compliance (collapse). The problem is when you injure too much tissue, i.e. a large surface area, you get excessive scar formation. Too much scar is BAD. For example, I always lecture on the key of a good pharyngeal operation is to try to preserve mucosa and limit tissue removal. The key of the operation is not how much tissue you remove, but is how you can manipulate the tissue by suturing to limit the airway collapse. Some surgeons remove a large strip of mucosa right next to the tonsils during a tonsillectomy (why? it is much easier), you will then create a large surface of raw wound. Even if the wound is sutured at the time of the operation, it will likely open up afterwards because there is too much tension on the wound. You are then left with a large surface area that will heal with a large scarred area. Additionally, if you also cut the soft palate (UPPP), you will further increase the scarred area and often create a near circumferential scarred surface. During the healing process, the wound contracts and leads to airway stenosis and the large scarred area causes all those side effects. If you look at my website on pharyngoplasty, you will see that all the mucosal tissues other than tonsils are preserved. The wounds are sutured in a direction that will pull up the soft palate and lateralize the lateral pharyngeal wall further. This way, the airway is opened up and less collapsible. Additionally, because all the mucosa is preserved, there is much less tension on the wound closure, thus the wound remain closed. The scar is just a linear scar and not a wide surface area. If you want further explanation, imaging if you remove all the skin on your palm versus just a cut with a knife on your palm that is sutured, that is the difference. Shall we move on to another topic?

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