Preoperative preparation of patients in plastic surgery and dermatosurgery

Preoperative preparation of patients in plastic surgery and dermatological surgery includes:

• collection of anamnesis,
• examination,
• consultations with the therapist, otolaryngologist, psychoneurologist, gynecologist. Dentist, nutritionist (not necessarily).
• if necessary, the appointment of drug therapy: vitamins (C, group B, E, rutin, folic acid, etc.), antioxidants (phosphadene, histochrome, selenium, silicon, etc.). Microelements (Zn, Cu, Fe, Se, Si), antiviral drugs,
• food additives (BAA),
• systemic enzyme therapy,
• rational nutrition.
• purification of the body (liver, intestine),
• preparation of the skin with the help of therapeutic and instrumental cosmetology,
• a course of general massage or massage of the collar zone and back.

Anamnesis.

In the process of collecting anamnesis, contraindications to operations that can be divided into absolute and relative can be found. Ignoring contraindications, can lead to deterioration of skin repair processes, prolonged inflammation, deepening and widening of the skin destruction zone and the appearance of pathological scars. When collecting an anamnesis, it is necessary to pay attention to the presence of herpetic infection. When preparing a patient for a face dermabrasion and having a history of Herpes Labialis, it is necessary to prescribe a preventive course for him with one of the antiviral drugs (zovirax, acyclovir, panavir, etc.) in tableted forms. For example, zovirax per course - 200 mg 5 times a day for 5 days.

In case of an unclear allergic history, it is recommended to prescribe one of the antihistamines before the operation for a week.

Absolute contraindications.

• Acute infectious and allergic diseases.
• Systemic and autoimmune diseases. 
• The state of immunodeficiency.
• Oncological diseases.
• Cirrhosis of the liver.
• Hypertensive disease II and III stage.
• Strokes, a history of heart attacks, the presence of a "pacemaker."
• Endocrinopathies with clinical manifestations.
• Diabetes.
• Pregnancy.
• Epilepsy.
• Mental diseases.
• The combination of several relative contraindications.

Relative contraindications:

• Chronic diseases in the period of remission.
• Foci of chronic infections (carious teeth, frontal sinuses, tonsillitis, and others).
• Menstruation. 
• Psychopathy.
• Propensity to hypertrophic and keloid scars.
• Reception of anticoagulants, fibrinolytics, antiaggregants.
• Reduced blood clotting.

Examination

• Clinical analysis of blood, urine.
• Blood on RW, AIDS, hepatitis markers.
• Biochemical blood test (glucose, cholesterol, ALT, ACT, C-reactive protein, clotting time, fibrinogen).

If necessary, an immunogram, blood on hormones (testosterone free and bound, prolactin, progesterone, luteinizing, follicle-stimulating hormones, ACTH thyroxin TU, TSH, cortisol, estradiol).

The doctor is obliged to inform the patient of all the acute issues associated with the operation, indications, contraindications, complications and scars. Where there will be scars, what they should be, what should be done so that they do not become wider, more noticeable.

The patient, in turn, at the primary reception signs special documents in 2 copies, in which he confirms his knowledge. Documents in two versions - "Informed consent" and "Agreement between the medical cosmetology center and the patient".

As a result, if there is any complication, the patient will not be able to make claims to the doctor that he was not informed of complications and scars and to demand material and moral compensation.

After the patient conducts the examination, all the specialists will pass, receive recommendations and, if necessary, drug therapy, the detailed preparation of the tissues for surgical intervention begins. And because, on how professionally this training was properly conducted, the postoperative period will depend. Ultimately, the results of the operation.

It is desirable to take at least 1-1.5 months for preoperative preparation. A rather large number of patients before aesthetic plastic surgery will be recommended to lose weight, and sharp weight loss can do more harm than good. This contingent should be left for preoperative preparation and weight loss - at least 3-5 months.

Cosmetological preparation of the patient before surgery

At this stage, the treating physician of the patient preparing for an aesthetic operation should be a cosmetologist. He can and should be able to prescribe a rational diet, recommend certain nutritional supplements (in relation to the patient's health condition), the course of microelements, vitamins, systemic enzyme therapy, cleansing measures for the intestine, liver, a certain set of physical exercises.

Oral treatment.

• vitamins C, A, E, group B;
• preparations and food additives containing vitamins, silicon, potassium, magnesium, calcium, zinc, selenium (selmevit, zinctal, alphabet, etc.):
• drugs to improve microcirculation (theonikol, andekalin, eskuzan 20, capillar);
• drugs that strengthen the vascular wall (ascorutin, etamzilate);
• immunomodulators (according to indications) - decaris, timogen, imunofan. Polyoxidonium, lycopide, etc .;
• preparations containing essential fatty acids (evening primrose oil, linetol).

Antibiotic therapy. Some authors suggest the use of antibiotic therapy before plastic surgery and dermabrasion to prevent infectious complications (139). In 63% of cases, drugs cephalosporin series, in 14% - dikloksatsiklin, 6% erythromycin. On the course - 7-8 days. Other authors believe that. Preventive antibiotic therapy does not reduce the possibility of infectious complications, but it can increase the resistance of the body to the antibiotic used, allergize the organism and increase the colonization of fungi of the genus Candida.

Antiviral therapy. About the risk of herpetic infection in the postoperative period, after deep chemical peelings and dermabrasion, especially in the perioral zone, surgeons and dermatosurgeons have been known for a long time. According to Perkins et all. In 9.9% of patients with a history of herpetic manifestations and without them, after dermabrasion and chemical peelings develop a herpetic infection. For prevention, he suggests the use of antiviral therapy, most often - zovirax (56%). For at least 8 days.

In addition to preparing the patient's body, the cosmetologist must prepare the tissues to make them easier to recover from the operation, without suppuration, swelling and aesthetically unacceptable scars. From what procedures should the cosmetological preparation of the patient before the operation consist?

The course of peeling or dermabrasion is a necessary stage in the patient's cosmetology preparation before the operation.

It goes without saying that when preparing patients for deep peelings or for operative dermabrasion, these procedures are not carried out. It is known that hyperkeratosis worsens gas exchange, increases hypoxia of the skin and creates conditions for the accumulation of metabolic products and free radicals in it. Peelings and therapeutic dermabrasion free the skin from thickened with the age of the stratum corneum, make it thinner, more elastic; stimulate the basal membrane and basal keratinocytes for active reparative processes.

Most often for these purposes, median peelings are used, 15-40% TCA (trichloroacetic acid), enzyme peels, 50-70 ° AHA (alpha hydroxy acids).

The pioneer in popularity among peelings are AHA. This is due to the fact that they have a combined effect on the skin - a peeling, moisturizing, immunostimulating, increasing the thickness of the dermis. The therapeutic effect of alpha-fruit acids depends not only on their concentration, but also on the pH. But the lower the pH the more the irritating effect of the procedure. The optimal pH is 3.5. Peelings with alpha-fruit acids are also good because the mechanism of their peeling action is associated with the destruction of intercellular bonds at the level of desmosomes and thus, the separated cells are easily eliminated leaving intact those cell layers on which the peeling solution did not work.

Working with peelings, you need to know about the side effects and complications (allergic reactions, hyperpigmentation, dyshromia, increased sensitivity of the skin) and observe all the nuances of technology. It is mandatory to use photoprotective, moisturizing, antioxidant, tyrosinase inhibitors, creams.

Patients can be recommended peelings in home care products of the firms Lierac (France), Gemiaine de Capuccini, Lacrima, Holy Land, GiGi, Doctor Nature (Israel), Natura Bisse (Spain), etc.

For patients who for some reason are not shown exfoliation, there is an alternative procedure - therapeutic dermabrasion (ultrasonic, sandblasting, oxygen). In order to achieve the optimal renewal and alignment of the stratum corneum, a course of procedures is performed. More often the procedures are performed 1 time in 4-7 days, depending on the thickness of removal of the epidermis layer per session, No. 5-7.

After the course of treatment with peeling or dermabrasion, the patient, depending on his problems, is given the following procedures:

• Microcurrent therapy with programs for tissue repair, myostimulation, lymphatic drainage, the administration of strengthening sera for a course of at least 15 sessions with an interval every other day.
• Hand massage of the face, neck, neckline, collar zone. The type of massage has no special value, it is possible to prescribe a therapeutic, plastic, acupressure, etc. Its positive effect on the microcirculation of the skin is important. Lymph drainage, as well as stimulating and tonic effect. One of the important properties of massage is its relaxing, antistress effect, beneficial effect on the central and autonomic nervous system. The course is appointed - no less than 10 procedures. 
• Mesotherapy. Appointed drugs that have a biostimulating effect; improving metabolism, microcirculation in tissues, promoting the stimulation of elastin, collagen production. Mesotherapy makes it possible to obtain an effect not only from the effects of pharmacological agents and needles on the skin, but also on the action on the biologically active points of the meridians of the bile and bladder, stomach, liver, small and large intestine. Normalization of the activity of these organs is one of the important conditions for the safe passage of the postoperative period, and, consequently, for obtaining optimal healing of postoperative sutures and wound surfaces. A course of treatment of 7-15 procedures is performed (depending on the drugs used).
• Laser therapy. Red light therapy in the paravertebral zones, biologically active points and directly on the skin in the field of future surgical intervention acts similarly to the above-described effects from mesotherapy. The course of treatment - 8-10 procedures.
• General massage of the body or back in an amount of 10-15 procedures. It is impossible to overestimate the role of such a course. Thanks to the massage, there is a generally restorative and tonic effect on the whole body and the skin in particular. Reflexively through the skin - to all internal organs and the central and autonomic nervous system.
• Application of physical methods.
• Use of local remedies, moisturizing, regenerating, improving microcirculation, strengthening the vascular wall.

It is known that tissue hypoxia is the basis of almost all postoperative complications and pathological scars in particular. In turn, additional supply of tissues and skin with oxygen promotes activation of cellular respiration, improvement of cell metabolism, enhancement of their synthetic and proliferative activity. In addition, oxygen is detrimental to the association of the microbial flora that inhabits the skin, especially anaerobic microorganisms.

Considering all these factors, Auriga International (Belgium) created the Chiroxy cream specifically for the purpose of improving the supply of oxygen to tissues. In the cream, oxygen is contained in the nanosomes, which facilitate the passage of oxygen through the lipids of the skin and the delivery of oxygen directly to the dermis.

Indications for use:

Chiroxy is indicated in the pre-peel and preoperative periods; when skin is transplanted, ulcers are treated; to accelerate the healing processes and prevent the formation of keloid scars. In the post-peeling and post-operation periods with the same processes. Especially relevant is the use of the cream in patients with reduced reactivity of the body, with a tendency to prolonged inadequate inflammation; in people who have a history of chronic diseases; in heavy smokers, patients with diabetes, atherosclerosis.

It is recommended to apply for 15 -20 days before the operation twice a day, applying a thin layer to the previously cleaned skin. Produced by 50 ml in a plastic tube.

To improve the microcirculation of the skin with success, you can use the domestic cream-gel capillar, which includes an extract from pine nuts and an extract of gingo biloba.

Gel AuridermHO ™ firm Auriga International (Belgium) - the drug, the main active ingredient of which is the oxide of vitamin K1, located inside the deposit.

Indications for use.

Is a means of prevention and treatment of hemorrhages, edema, hematomas, couperose, congestive erythema. Due to the presence of vitamins A, C and E has antioxidant and anti-inflammatory effect.

It is shown, as a means of preoperative preparation of patients before plastic operations, operative dermabrasion.

Auriderm XO ™ also accelerates the elimination of hemosiderin from tissues after sclerotherapy.

It is recommended to use to accelerate the resolution of postoperative hematomas, edema.

Issued by:

• in the form of a gel in metal tubes, a volume of 30 and 75 ml.
• in the form of a stick, 4 ml. It is recommended for the treatment of small hemorrhages.

Application:

It is applied twice a day in the morning and evening by rubbing into the skin with light massaging movements. The introduction of the gel with the help of ultrasound enhances its action.

All these procedures will act in one key, causing better microcirculation and lymphatic drainage in the skin, exerting a strengthening effect on the vessels and the body as a whole, on its immune system and adaptation mechanisms. Thus, preparations are made for surgical interventions, which is a system for preventing postoperative complications and pathological, aesthetically unacceptable scars.

When preparing patients for dermabrasion or for deep chemical peels, it is recommended that the skin be treated for a month:

Topical retinoids in the form of creams: 0.05% tretinoin cream, radevit, diferin or professional cosmetics company ROC (France), containing retinoids.

The use of topical retinoids before these procedures is justified by the fact that they:

• stimulate the migration and mitotic activity of keratinocytes,
• stimulate the formation on fibroblasts of more receptors to the epidermal growth factor,
• increase the synthesis of fibroblasts by mucopolysaccharides, collagen, fibronectin,
• promote dehydration and elimination of corneocytes, possessing peeling properties.

Creams containing AHA or glycolic acid or light peels with 3-5% glycolic acid.

Alpha fruit acids (AHA) and, having the smallest molecular weight glycolic acid:

• reduce the cohesion of corneocytes and, correspondingly, the thickness of the stratum corneum,
• increase the synthetic and proliferative activity of fibroblasts,
• increase the synthesis of collagen, elastin, glycosaminoglycans,
• increase the hydrophilicity of the dermis.

Thus, these drugs restore the thickness of the dermis, its metabolism, vascularization, reduce the thickness of the stratum corneum and thicken the epidermis, which allows obtaining optimal results after peeling and dermabrasion.

To apply creams containing antioxidants, improving, microcirculation, strengthening the vessel wall: Chiroxy, Auriderm, Kapilar, Serum Flavo-C (Auriga International, Belgium).

[1], [2], [3], [4]