Abstract
Introduction
. According to statistics, about 50 % of patients experience scar-related complications during the postoperative period. The effects of a scar can extend far beyond its visible physical boundaries. Somatic dysfunctions in the scar area manifest themselves at the biomechanical, hydrodynamic, and neurodynamic levels. In the osteopathic literature, the authors have not found detailed structured information on the diagnosis and long-term correction of somatic dysfunctions in the scar area using osteopathic methods.
The aim of the study
: to study a wide range of somatic dysfunctions in the scar area. Objectives: to study the relationship of somatic dysfunctions with the anatomical and physiological features of the scar region, with anamnestic data, with operative techniques, and with the features of the postoperative period.
Materials and methods
. A cohort prospective study was conducted from January 2021 to December 2025 at the «Dalin» Medical Center (Khabarovsk). A group of 92 patients with scars after a Pfannenstiel cesarean section, with an average age of 37±7,8 years. The patients had undergone the surgery between 7 days and 20 years ago, with an average of 7,6±5,1 years. The patients visited an osteopath with complaints of various pain syndromes. At the same time, only some of them (16 %, n=15) actively complained about the scar area, mostly with an operation that was no more than a year old. The diagnosis at the osteopathic appointment was conducted according to clinical recommendations, as well as using specific techniques, including the author′s own. The data collected during the study was saved using Microsoft Excel and processed using Statistica 10.0.
Results
. At the biomechanical level, the traction of the scar can be determined by dynamically listening to the muscles of the anterior abdominal wall as they contract, as well as by actively displacing the tissues. At the hydrodynamic level, the vectors of the scar′s traction can be determined by locally osteopathic listening to the involuntary rhythms of the tissue. This allows for accurate diagnosis of the traction not only towards the visible horizontal part of the scar, but also towards the hidden vertical part of the scar. It is also possible to identify more complex areas of the scar and fascial adhesions in the femoral triangle region. The author′s test for the consistency of regional lymph fl ow (the «slap» test) can be used to determine the areas of secondary lymphatic edema. At the neurodynamic level, it is possible to identify hypoesthesia, hyperalgesia, and allodynia using standard neurological examination methods. Muscle testing (uniphasic or biphasic) can be a valuable additional method.
Conclusion
. knowledge of the layered topography of tissues in the scar area allow us to predict the types of somatic dysfunctions that an osteopath may detect in the scar area. The combination of these tests allows for an accurate topographic diagnosis of the various levels of somatic dysfunctions in the scar area.