Patient care after surgical dermabrasion

For successful restoration of the skin after surgery it is necessary:

• the presence of fragments of the basement membrane with basal keratinocytes, fragments of hair follicles and sweat glands with cambial cells,
• creation of a moist environment in the wound surface for the free movement of keratinocytes and fibroblasts,
• ensure the presence of hyaluronic acid, collagen, fibronectin, and proteoglycan molecules in the wound,
• the presence of mediators that promote acceleration of epithelialization (fibroblast growth factor, epidermal growth factor, insulin-like growth factor),
• relieve inflammation,
• normalize the synthesis and breakdown of collagen,
• neutralize the action of transforming growth factor-beta.
• After the wound coverings or scabs have fallen off and epithelialization has occurred, protect the postoperative surface from UV radiation for at least 2 months.

Some of these tasks can be accomplished through proper wound care management, knowledge of current trends in this area, and awareness of the availability and options of modern wound dressings.

For a long time, in centers performing surgical resurfacing, the most successful means of caring for the postoperative surface was a 5% solution of KMnO4. It is no secret that this means continues to be used today, although it is known that it causes additional irritation of the skin and can lead to an increase in the inflammatory reaction in it, deepening of destructive processes with the formation of atrophic skin, hypopigmentation and scars.

Over the last decade, new trends have emerged in the management of wound surfaces, burn wounds, trophic ulcers, etc. Drying procedures and compositions that disinfected the wound and created a scab, which is also a protective coating, are becoming an anachronism. Experimental data have emerged that the healing process of wound surfaces of the skin is much more active in a humid environment. Thus, it was proven that for successful restoration of the skin after injury, it is necessary to create a humid environment on the wound surface for the free movement of cells and the activity of enzymes that promote the destruction of necrotic tissue. Various wound dressings began to be created from fibrin, collagen, silicone, hydrocolloids, hydrogels, alginates, with hyaluronic acid, chitosan - substances that retain a large number of water molecules and thus create a humidified environment in the wound. The presence of hyaluronic acid, collagen, fibronectin, and proteoglycans in the wound coating not only creates a moist environment in the wound, but also accelerates reparative processes and increases local immunity. In addition to these components, antiseptics are introduced into the wound coatings. This complex allows you to speed up the healing process and create maximum conditions for scarless healing during deep grinding and deep peeling.

There are several classifications of wound dressings.

So, according to the degree of isolation of wound surfaces from the environment, they can be divided into:

1. Occlusive.

These are various air-impermeable, sterile, biocompatible films. Occlusive dressings create conditions in the wound for the growth of bacterial flora, especially anaerobic, which prevents rapid healing. However, they can be used for 24-48 hours after aseptic treatment of the wound surface.

2. Semi-occlusive, not interfering with gas exchange in the wound surface.

Representatives of this group are hydrogel and Vaseline dressings. Antibiotics are introduced into them, due to which the dressings have antibacterial properties. Hydrogel dressings are also good adsorbents. Therefore, their use gives the least number of complications.

3. Non-occlusive.

These include antiseptic solutions; ointments, creams containing antibiotics, corticosteroids, vitamins A, E, C, aloe, bovine collagen, etc. Care for wound surfaces and scars can also be carried out using the above-mentioned means in the absence of semi-occlusive drugs.

Another option for classifying wound dressings is by the degree of naturalness of their components.

1. Synthetic.

Hydrocolloids, polyurethane films with pores, films and membranes made from synthetic polypeptides.

2. Biological.

Allogeneic skin, cadaveric skin, fresh and frozen amnion, bovine collagen, pig skin, keratinocyte culture, artificial skin analogue.

3. Biosynthetic.

For example, a layer of collagen on a silicone membrane.

Most often, wound dressings are classified by dosage form:

• ointments,
• creams,
• aerosols,
• films,
• hydrogels, etc.

Requirements for wound coverings and dressings:

They should be:

• easy to use,
• made from biologically neutral material,
• elastic, easily take the shape of surfaces of complex configuration,
• protect the wound surface from the penetration of infectious agents from the outside,
• bactericidal.
• absorb exudate and create a moist aseptic environment in the wound,
• easily removed from the wound,
• affordable.

In addition, it is useful to have immunostimulating, antioxidant, microelement, and moisture-retaining components in wound dressings. Unfortunately, there is no ideal wound dressing today, but the large selection of wound care products that has appeared allows the doctor to provide proper postoperative care and achieve good results by combining the available products.

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