Care of patients after plastic surgery

Postoperative care for patients in aesthetic plastic surgery and dermatosurgery consists of the appointment of:

• drugs for internal therapy:
  • antibiotics (if necessary),
  • vitamins, microelements, antioxidants, systemic enzyme therapy;
• rational nutrition;
• professional approach to the treatment of wound surfaces and postoperative sutures;
• cosmetic rehabilitation procedures.

It is necessary to start the procedures almost immediately after the operation to help the body cope with lymphostasis, ischemia, edema, hematomas and to avoid inflammation. Physiotherapists recommend starting postoperative rehabilitation from the third day after the operation and up to the seventh day using only contactless methods, such as UFO, UV, microwave, red therapeutic laser, magnetic therapy. From the seventh day, you can start using contact methods. The duration of the procedure depends on the area of exposure. The text indicates the maximum exposure time.

• Lymphatic drainage.

The softest and most harmonious effect can be achieved with microcurrent devices. The course consists of 10-15 sessions, daily starting from the third day after the operation, very gently touching the skin. Procedures for working with scars on microcurrent devices are used, for example, the ENTER program on Bioterapuetic Komputer devices. Cotton cardboard swabs soaked in conductive gel are installed gently touching the skin without pressure in the area of postoperative sutures, edematous zones.

• Ultra-high purity therapy (UHF).

Condenser plates are installed at a distance of 2-3 cm from the skin. High-frequency electromagnetic oscillations with a frequency of 20 to 50 MHz are used. The UHF electric field causes oscillations of the macromolecular components of the connective tissue, which leads to an increase in tissue permeability and lymphatic drainage, improvement of microcirculation, and a decrease in hypoxia. Sessions are held daily or every other day for 10-15 minutes No. 8-10.

• Ultra-high frequency therapy (UHF).

High-frequency electromagnetic oscillations with a frequency of up to 2450 MHz are used. Microwave has a softer effect on tissues than UHF. Sessions are held daily or every other day for 10-15 minutes No. 8-10.

• Ultrasound of the postoperative area.

Ultrasonic vibrations with a frequency of 880 to 3000 kHz are used. Power - from 0.05 - 0.4 W/cm2 to 1.0 W/cm2. The therapeutic effect consists of 3 moments: mechanical, thermal, physicochemical. In the pulse mode, the thermal factor is absent.

Due to the acceleration of biomolecule movement under the influence of ultrasound, metabolism in tissues is enhanced, the viscosity of interstitial fluid is reduced, tissue drainage is enhanced, microcirculation is improved, and hypoxia is reduced. The procedure is carried out using a conductive gel; it is more effective to use the "Lioton-100" gel based on heparin or Auriderm XO™ gels with vitamin Kl, Chiroxy, capilar.

It is better not to perform ultrasound treatment directly on the area of postoperative sutures, as this can cause their failure, especially in areas of increased functional load and in cases of a tendency to pathological scars.

It is recommended to have 10-15 sessions, 10-15 minutes every other day or daily.

• Laser therapy.

Low-intensity lasers with red and infrared radiation are used.

Both types of radiation have a similar effect on tissues: they activate enzyme systems, cellular respiration, tissue metabolism, synthetic and proliferative activity of fibroblasts, and reparative processes. They cause dilation of microcirculatory vessels and, as a consequence, lymphatic drainage, hypoxia relief, and improved removal of decay products and free radicals from the surgical area. Wavelength from 0.632 μm to 1.2 μm.

The application points are the areas of the operation, the corresponding paravertebral and segmental-reflexogenic zones. In addition, the therapeutic laser allows laser puncture to be performed on biologically active points.

Laserphoresis can be performed using a semiconductor pulsed therapeutic gallium arsenite laser (Helios-01) with a wavelength of 890-950 nm, pulse frequency of 300 to 3,000 Hz and power of up to 15 W. The duration of the session is 10 minutes. There are 10 procedures per course. The number of courses is 3-5, with an interval of one month.

Vascular sclerotherapy. It is performed using lasers with a wavelength of 585-600 nm. This technology is used to reduce the volume of keloid scars, as it worsens their trophism, obliterating the vessels that feed the keloid. In addition, it allows you to eliminate dilated vessels on the surface of scars that appeared after treatment with corticosteroid and cytostatic drugs.

• Medicinal electrophoresis on the scar area.

Immediately after epithelialization of the wound surface, the following preparations can be used to improve the appearance of the resulting scars: potassium iodide from the (-) pole, lidase (acidified solution 64-128 U from the (+) pole), bee venom preparations - apizartron, apitoxin, apifor from the (+ and -) poles. Current strength - according to the patient's sensations, time 15-15 minutes, per course of 15-20 sessions every other day.

Medicinal electrophoresis can also be carried out using microcurrents on microcurrent devices, with a current strength of up to 180 microamps and a frequency of 250-300 Hz on the iontophoresis program. The course of treatment is 10-15 procedures, every other day or daily. The number of courses is 2-3, with an interval of 2-3 weeks.

Care must be taken when prescribing procedures directly to the area of postoperative sutures. In places where the skin near the scars and underlying tissues are subject to stress and stretching, the loose scar tissue, after additional physiotherapy procedures, may prove insolvent and stretch. A wide scar at the incision site after plastic surgery can negate its results and lead to complaints from patients.

• Magnetic therapy.

Pulsed and low-frequency magnetic therapy is used.

Pulsed magnetic therapy causes the formation of vortex electric fields in tissues, which induce electric currents that excite vegetative fibers and cause contraction of vascular smooth muscles. As a result, tissue trophism, microcirculation and drainage are improved. Magnetic field inductors can be placed stationary on the skin or moved around the surgical intervention area.

Low-frequency magnetic therapy causes multidirectional movement of ions in tissues, as a result of which metabolism in cells is enhanced, which also leads to improved reparative processes, accelerated removal of decay products and improved aesthetics of postoperative scars.

Magnetic fields with induction of 1.2-1.7 T are used.

The course of treatment consists of 10-12 procedures, every other day or daily, for 10-15 minutes.

• Application of low and medium frequency electric currents.

D'arsonval.

Darsonval is a treatment with weak pulsed alternating currents of medium frequency and high voltage. The currents irritate free nerve endings in the skin, which leads to a reaction of the vascular bed with improved microcirculation. Micronecrosis occurring in the skin under the influence of spark discharges leads to microfocal aseptic inflammation with the release of growth factors, cytokines, and inflammation mediators. The spark discharge also has a bactericidal effect on the skin flora.

The entire skin in the area of the operation is treated with a mushroom-shaped electrode at medium current settings on the 2nd-3rd day after the operation, daily or every other day, alternating with other physiotherapeutic procedures, for a course of 8-10 sessions of 10-15 minutes.

• Bucky irradiation or close-focus x-ray therapy

In case of a tendency to the appearance of pathological scars, for preventive purposes, immediately after the removal of the sutures it is necessary to do 1 session of Bucky irradiation. The scab and suture material prevent the penetration of rays into the tissue.

Soft X-rays in therapeutic doses do not have a general effect on the body. They penetrate the skin by 3-4 mm and act locally, causing a cytostatic effect on cells with increased metabolism. In keloid scars, these are pathological giant fibroblasts. In addition, they have a fibrinolytic effect on young connective tissue (immature collagen fibers), so they can be successfully used in the treatment of keloid scars that have already appeared.

• Ointment treatment.

Starting from the 10th to 14th day, lubricate the postoperative sutures with solcoseryl, actovegin ointments, curiosin, chitosan gel, cel-T, etc., 2 times a day, for at least 2 months, it is advisable to alternate ointments. If there is a tendency to keloid or hypertrophic scars, it is recommended to treat the postoperative sutures with contractubex, kelofibrase, lazonil, hydrocortisone ointment. In addition, treatment with film-forming varnishes and compression therapy are indicated (see treatment of keloid scars).

In the case of hemorrhages and hematomas, such preparations as Auriderm XO&trade, Chiroxy, and capilar have an invaluable effect. The preparations should be applied to the skin 3-4 times a day or administered using phonophoresis.

Note:

• Light manual massage can be started no earlier than 1.5 months after surgery.
• It is recommended to use any masks no earlier than 2 months after the operation, since when they are removed from the face, the skin may stretch, which can lead to the formation of hemorrhages and deterioration of the appearance of scars.

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