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seems everyone's having surgery to remove post-surgical scar tissue

Posted by elliott on 8/27/01 at 00:05 (058069)

There seems to be an awful lot of people on this forum having surgery to remove post-surgical scar tissue following a TTS release. I'd bet a scar tissue mess is often suggestive of poor technique by the surgeon (e.g. how he cuts, how he shpritzes the anti-scar liquid, how he sews) although maybe some would argue that scar tissue is more of a problem when dealing with small sensitive nerves of TTS than in general (any of the docs here like to comment on that?). My first surgeon (right foot) left what I think was a scar tissue mess (as evidenced in part by hard spots on my skin near the surgical incision), among other things, that weakened my foot (never liked him). My second surgeon (left foot) did such a neat job that I barely feel I had surgery, but then, there's the TTS that recurred in that foot.

I was wondering if we could have a discussion regarding surgery to remove scar tissue following a TTS release. In particular:

1. Isn't it likely that another surgery to remove scar tissue will just generate even more scar tissue, with the risk perhaps outweighing the potential gain?

2. One of the causes for TTS release failure is that scar tissue re-forms over the very area released, re-trapping the nerve(s). Wouldn't a surgery to remove scar tissue follwing such a release be particularly risky in this case, in that it could re-entrap the nerve? (The first two questions are sort of the same but with some nuances of difference in emphasis.)

3. Aren't there other ways to break up scar tissue? I don't see any discussion of that here. After waiting a year and a half and foot getting weaker and weaker, pain increasing, and contemplating a second surgery, I started doing some cycling and powerful power yoga poses (for those who have trouble standing, you don't need to stand for them, but you may need to be reasonably flexible to safely attempt them) that have brought my troublesome right foot to near normalcy; I would've never believed it. I can talk about that later if you are interested.

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Re: seems everyone's having surgery to remove post-surgical scar tissue

Donna SL on 8/27/01 at 05:11 (058075)

Elliott,

Techniques like myofacial release, active release technique (ART), etc, have been used for years to remove scar tissue from all kinds of surgeries, from failed carpal tunnel surgery to abdominal surgeries. This is not a new concept.

Also, have you tried any type of injection therapy from a physiatrist other than cortisone to get rid of the scar tissue, or get other suggestions for treatment? I would try the ART first, but still see a physiatrist if you haven't already, because they are trained in conservative treatments. I mentioned in my posting in April on ART about a women who had two failed carpal tunnel surgeries, who was loaded with scar tissue that was almost cured with ART at the time I met her in the waiting room. I'm sure by now she's done. I don't see her any more. She was the patient of the other doctor in the office that I go to.

Donna

Re: Scar Tissue Patient

Mike M on 8/27/01 at 07:26 (058078)

I had a third op to remove scar tissue. It wasnt the first choice, we tried PT, scar tissue management, etc. To no avail. This time we are even using Medurma cream. Blood tests (not related to TTS) show an elevated ANA, white blood count >20,000, but negative RF. My family doc believes I have an Auto Immune disorder (hence Graves Disease of 20 yrs ago). Something similiar to Lupus - although not being female, he calls it Mixed Connective Tissue Disease. Both docs believe this, in my case, is what caused the excessive scar tissue formation from the original op. My bodies immune system going into overdrive.
How did the scar tissue removal surgery go?
Only time will tell. I can tell you, some of the same symptoms are back - sans pre surgery. AND I was told it may not be 100% successful.
Therefore, YOU need to ask, find out why its done, and if your in a case similiar to mine, after you run out of conservative treatments, you TRY anything!

Re: seems everyone's having surgery to remove post-surgical scar tissue

AJ on 8/27/01 at 09:27 (058087)

In regard to your third point, isn't ultrasound, scar massage, and physical therapy(stretching) done to reduce scar tissue? Did you have this done following your surgeries?

Re: seems everyone's having surgery to remove post-surgical scar tissue

Mike M on 8/27/01 at 11:16 (058092)

If your asking me, which Im not sure you are, but in my case -
PT, ultrasound, stretching, scar tissue management was done AFTER the first PF and TTS in Feb. The incision was then opened back up on June 22nd to remove the worm like mass.

Re: never had any of that stuff

elliott on 8/27/01 at 11:43 (058100)

Was never offered it either (although it may have helped for my first foot). My impression is, if they do the surgery right, you start walking in two weeks and start running in six. I intended my post more as query to those who have had additional surgery to remove scar tissue than as seeking specific help for myself. I'm just wondering aloud if they tried all avenues to rid themselves of that scar tissue (in particular, exercise where you move or stretch the foot, even if it's not part of an official PT program) before opting for surgery to remove it.

Re: never had any of that stuff

cindyp on 8/27/01 at 15:25 (058120)

Don't know about scar tissue. Had surgery and June and am relatively okay. Don't run because I don't want to take the chance on twisting the ankle. Feel pretty good most times once in awhile an electric twinge not to often though.

Re: seems everyone's having surgery to remove post-surgical scar tissue

Ed Davis, DPM on 8/27/01 at 22:56 (058189)

Scar tissue begets more scar tissue. Re-operation for scar tissue removal often causes more scar tissue and is to be performed if the amount of scar tissue is excessive.

I have made numerous posts on alleviation of scar tissue without surgery.
The primary medications are hyaluronidase (Wydase) which is an enzyme that breaks down (digests) scar tissue and triamcinolone acetonide, a powerful steroid that must be injected carefully in proximity to tendons.

Good surgical technique, physical therapy after surgery and post-operative control of swelling are some tools that prevent scar tissue from forming.
Ed

Re: hyaluronidase (Mydase)

Matt L. on 8/29/01 at 15:18 (058363)

I haven't heard of this for scar tissue from a tarsal tunnel release. Is it common? It is like cortisone?

Re: hyaluronidase (Mydase)

Ed Davis, DPM on 8/29/01 at 22:59 (058411)

Hyaluronidase (trade name is Wydase since Wyeth Phamaceuticals is the main manufacturer) is a synthetic form of an enzyme found in our bodies, the function of which is to break down scar tissue. The synthetic concentrated form is an effective injection to help break down scar tissue. (It basically helps 'digest' scar tissue)

Cortisone is not an enzyme but the form often used for scar tissue reduction, triamcinolone acetonide (Kenalog), is a potent agent for tissue atrophy, not necessarily specific for scar tissue.

Scar tissue in the tarsal tunnel is not necessarily different from other types of scar tissue so the above substances can be used anywhere scar tissue reduction is desirable including the tarsal tunnel.
Ed

Re: seems everyone's having surgery to remove post-surgical scar tissue

Donna SL on 8/27/01 at 05:11 (058075)

Elliott,

Techniques like myofacial release, active release technique (ART), etc, have been used for years to remove scar tissue from all kinds of surgeries, from failed carpal tunnel surgery to abdominal surgeries. This is not a new concept.

Also, have you tried any type of injection therapy from a physiatrist other than cortisone to get rid of the scar tissue, or get other suggestions for treatment? I would try the ART first, but still see a physiatrist if you haven't already, because they are trained in conservative treatments. I mentioned in my posting in April on ART about a women who had two failed carpal tunnel surgeries, who was loaded with scar tissue that was almost cured with ART at the time I met her in the waiting room. I'm sure by now she's done. I don't see her any more. She was the patient of the other doctor in the office that I go to.

Donna

Re: Scar Tissue Patient

Mike M on 8/27/01 at 07:26 (058078)

I had a third op to remove scar tissue. It wasnt the first choice, we tried PT, scar tissue management, etc. To no avail. This time we are even using Medurma cream. Blood tests (not related to TTS) show an elevated ANA, white blood count >20,000, but negative RF. My family doc believes I have an Auto Immune disorder (hence Graves Disease of 20 yrs ago). Something similiar to Lupus - although not being female, he calls it Mixed Connective Tissue Disease. Both docs believe this, in my case, is what caused the excessive scar tissue formation from the original op. My bodies immune system going into overdrive.
How did the scar tissue removal surgery go?
Only time will tell. I can tell you, some of the same symptoms are back - sans pre surgery. AND I was told it may not be 100% successful.
Therefore, YOU need to ask, find out why its done, and if your in a case similiar to mine, after you run out of conservative treatments, you TRY anything!

Re: seems everyone's having surgery to remove post-surgical scar tissue

AJ on 8/27/01 at 09:27 (058087)

In regard to your third point, isn't ultrasound, scar massage, and physical therapy(stretching) done to reduce scar tissue? Did you have this done following your surgeries?

Re: seems everyone's having surgery to remove post-surgical scar tissue

Mike M on 8/27/01 at 11:16 (058092)

If your asking me, which Im not sure you are, but in my case -
PT, ultrasound, stretching, scar tissue management was done AFTER the first PF and TTS in Feb. The incision was then opened back up on June 22nd to remove the worm like mass.

Re: never had any of that stuff

elliott on 8/27/01 at 11:43 (058100)

Was never offered it either (although it may have helped for my first foot). My impression is, if they do the surgery right, you start walking in two weeks and start running in six. I intended my post more as query to those who have had additional surgery to remove scar tissue than as seeking specific help for myself. I'm just wondering aloud if they tried all avenues to rid themselves of that scar tissue (in particular, exercise where you move or stretch the foot, even if it's not part of an official PT program) before opting for surgery to remove it.

Re: never had any of that stuff

cindyp on 8/27/01 at 15:25 (058120)

Don't know about scar tissue. Had surgery and June and am relatively okay. Don't run because I don't want to take the chance on twisting the ankle. Feel pretty good most times once in awhile an electric twinge not to often though.

Re: seems everyone's having surgery to remove post-surgical scar tissue

Ed Davis, DPM on 8/27/01 at 22:56 (058189)

Scar tissue begets more scar tissue. Re-operation for scar tissue removal often causes more scar tissue and is to be performed if the amount of scar tissue is excessive.

I have made numerous posts on alleviation of scar tissue without surgery.
The primary medications are hyaluronidase (Wydase) which is an enzyme that breaks down (digests) scar tissue and triamcinolone acetonide, a powerful steroid that must be injected carefully in proximity to tendons.

Good surgical technique, physical therapy after surgery and post-operative control of swelling are some tools that prevent scar tissue from forming.
Ed

Re: hyaluronidase (Mydase)

Matt L. on 8/29/01 at 15:18 (058363)

I haven't heard of this for scar tissue from a tarsal tunnel release. Is it common? It is like cortisone?

Re: hyaluronidase (Mydase)

Ed Davis, DPM on 8/29/01 at 22:59 (058411)

Hyaluronidase (trade name is Wydase since Wyeth Phamaceuticals is the main manufacturer) is a synthetic form of an enzyme found in our bodies, the function of which is to break down scar tissue. The synthetic concentrated form is an effective injection to help break down scar tissue. (It basically helps 'digest' scar tissue)

Cortisone is not an enzyme but the form often used for scar tissue reduction, triamcinolone acetonide (Kenalog), is a potent agent for tissue atrophy, not necessarily specific for scar tissue.

Scar tissue in the tarsal tunnel is not necessarily different from other types of scar tissue so the above substances can be used anywhere scar tissue reduction is desirable including the tarsal tunnel.
Ed