wound healing question

[rahulb]

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so you did a lumpectomy on a 37 y/o female 2 weeks ago

she's back today for sentinel node dissection and reevaluation of the primary margins.

you make an incision directly over the old incision site 2 weeks prior, remove the tissue and closer her up.

will wound healing begin anew or continue from the initial incision 2 weeks prior?

i was thinking that since the fibroblasts are already at the incision site (from the previous surgery), they'll continue laying collagen. or maybe they trauma sustained from the 2nd incision restarts the healing process?

anyone know for sure?

 

[opr8n]

lots of issues here
im sure WS will correct me on some of them

why wasent the SLNB done at time of org surgery?
did you not have path prior to doing lumpectomy?
its a SLN biopsy, not dissection
If the margin were + why didnt you resect skin margins, most people i know do that?
Why were you doing the SLNB through the lumpectomy incision?

so you did a lumpectomy on a 37 y/o female 2 weeks ago

she's back today for sentinel node dissection and reevaluation of the primary margins.

you make an incision directly over the old incision site 2 weeks prior, remove the tissue and closer her up.

will wound healing begin anew or continue from the initial incision 2 weeks prior?

i was thinking that since the fibroblasts are already at the incision site (from the previous surgery), they'll continue laying collagen. or maybe they trauma sustained from the 2nd incision restarts the healing process?

anyone know for sure?

 

[SLUser11]

lots of issues here
im sure WS will correct me on some of them

why wasent the SLNB done at time of org surgery?
did you not have path prior to doing lumpectomy?
its a SLN biopsy, not dissection
If the margin were + why didnt you resect skin margins, most people i know do that?
Why were you doing the SLNB through the lumpectomy incision?

Who knows what the original core biopsy showed...it could have been non-invasive cancer, i.e. DCIS, which would explain the nodes not being taken. Or, it could have been an open biopsy that the OP called a "lumpectomy."

As for skin margins, if the skin margin wasn't positive, I'm not sure you'd need to excise any skin. You would only need to take more margins where they were close (or positive). I'd be interested to hear WS's thoughts as well, because I don't see an oncologic advantage to taking more skin routinely.

To answer the OP's original question, which has more to do with wound healing than the specifics of breast disease manangement, if you reopen a wound, it heals faster the second time around, depending on the timeline. This is something you can look up in a basic surgical textbook, though, which would probably give you a more detailed answer regarding the timeline of PMNs, fibroblasts, collagen (I and III), etc.

 

[Winged Scapula]

As for skin margins, if the skin margin wasn't positive, I'm not sure you'd need to excise any skin. You would only need to take more margins where they were close (or positive). I'd be interested to hear WS's thoughts as well, because I don't see an oncologic advantage to taking more skin routinely.

Lots of issues with how the patient in the OP's post is presented, but that wasn't his/her question.

There is not oncologic advantage to taking skin unless you have a positive anterior margin.

As a matter of fact, probably greater than 95% of my lumpectomy incisions are periareolar and not directly over the tumor/mass/area of concern. I only routinely take skin if the lesion is involving the skin or abutting the dermis and I am worried about a positive skin margin.

To answer the OP's original question, which has more to do with wound healing than the specifics of breast disease manangement, if you reopen a wound, it heals faster the second time around, depending on the timeline. This is something you can look up in a basic surgical textbook, though, which would probably give you a more detailed answer regarding the timeline of PMNs, fibroblasts, collagen (I and III), etc.

Yep...the wound has been populated by the above cells and will heal faster, However, it will be less cosmetically appealing if you open the same incision so I always excise old scar.

 

[maxheadroom]

Yep...the wound has been populated by the above cells and will heal faster, However, it will be less cosmetically appealing if you open the same incision so I always excise old scar.

Agreed. In general, I try not to resuture a healing scar -- you're much better off to freshen the edges a bit.