Care of patients after operative dermabrasion

To successfully restore the skin after surgery, you need:

• presence of fragments of the basal membrane with basal cortinocytes, fragments of hair follicles and sweat glands with cambial cells,
• the creation of a moist environment in the wound surface for the free movement of keratinocytes and fibroblasts,
• the presence of molecules of hyaluronic acid, collagen, fibronectin, proteoglycans,
• the presence of mediators that promote the acceleration of epithelialization (fibroblast growth factor, epidermal growth factor, insulin-like growth factor),
• remove inflammation,
• normalize the synthesis and decomposition of collagen,
• neutralize the effect of the transforming growth factor-betta.
• after the falling off of the wound coverings or the scab and epithelization, to protect the postoperative surface from the UFO for not less than 2 months.

Some of these tasks can be performed by competent management of wound surfaces, knowledge of current trends in this field and awareness of the presence and options of modern wound coverings.

For a long time, 5% solution of KMnO4 was used as the most effective means of care for the postoperative surface in the centers that make operative polishing. It is not a secret that even today this remedy continues to be used, although it is known that it causes additional skin irritation and can lead to an increase in inflammatory reaction in it, deepening of destructive processes with the formation of atrophic skin, hypopigmentation and scarring.

Over the past decade, new trends have emerged in the management of wound surfaces, burn wounds, trophic ulcers, etc. Drying procedures and compositions that disinfect the wound and create a scab that is simultaneously a protective coating become an anachronism. There were experimental data that the process of healing of wound skin surfaces is much more active in a moist environment. Thus, it was proved that to successfully restore the skin after trauma it is necessary to create a moist environment on the wound surface for free movement of cells and the activity of enzymes that contribute to the destruction of necrotic tissues. Various wound coatings of fibrin, collagen, silicone, hydrocolloids, hydrogels, alginates, hyaluronic acid, chitosan - substances holding a large number of water molecules were created, thus creating a moistened environment in the wound. The presence in the wound coating of molecules of hyaluronic acid, collagen, fibronectin, proteoglycans not only creates a moist environment in the wound, but also speeds up the reparative processes, increases local immunity. In addition to these components, wound dressings are treated with antiseptics. Such a complex allows to accelerate the healing process and create the maximum conditions for the non-scarring healing with deep grinding and deep peelings.

There are several classifications of wound coverings.

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

1. Occlusive.

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

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

Representatives of this group are hydrogel and vaseline dressings. In them antibiotics are introduced, due to what bandages have antibacterial properties. Hydrogel dressings are also good adsorbents. Therefore, their use gives the least amount 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 be carried out by the above mentioned means in the absence of semi-occlusive preparations.

Another variant of systematization of wound coverings is the degree of naturalness of their components.

1. Synthetic.

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

2. Biological.

Allogeneic skin, cadaver 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 covers are systematized according to dosage forms:

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

Requirements for wound dressings and dressings:

They should be:

• easy to use,
• are made of a biologically neutral material,
• elastic, easy to take the form of surfaces of a complex configuration,
• protect the wound surface from the infiltration of infectious agents from the outside,
• bactericidal.
• absorb the 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, water-retaining components in wound coverings. Unfortunately, there is no ideal wound covering today, but a large selection of wound care products allows the doctor to perform correct postoperative care and to obtain good results by combining the available funds.

[1], [2], [3]