Preoperative preparation of patients in plastic surgery and dermatosurgery

Preoperative preparation of patients in plastic surgery and dermatosurgery includes:

• anamnesis collection,
• examination,
• consultations with a therapist, otolaryngologist, neuropsychiatrist, gynecologist, dentist, nutritionist (optional).
• if necessary, prescribe drug therapy: vitamins (C, B group, E, rutin, folic acid, etc.), antioxidants (phosphaden, histochrome, selenium, silicon, etc.), microelements (Zn, Cu, Fe, Se, Si), antiviral drugs,
• food additives (BAA),
• systemic enzyme therapy,
• rational nutrition.
• cleansing the body (liver, intestines),
• skin preparation using therapeutic and hardware cosmetology tools,
• a course of general massage or massage of the collar zone and back.

Collection of anamnesis.

During the anamnesis collection, contraindications to operations may be detected, which are divided into absolute and relative. Ignoring contraindications may lead to deterioration of skin reparation processes, prolonged inflammation, deepening and expansion of the skin destruction zone and the appearance of pathological scars. When collecting anamnesis, it is necessary to pay attention to the presence of herpes infection. When preparing a patient for facial dermabrasion and having a history of Herpes Labialis, it is necessary to prescribe him a preventive course of one of the antiviral drugs (zovirax, acyclovir, panavir, etc.) in tablet form. For example, zovirax per course - 200 mg 5 times a day for 5 days.

If the allergy history is unclear, it is recommended to prescribe one of the antihistamines for a week before the operation.

Absolute contraindications.

• Acute infectious and allergic diseases.
• Systemic and autoimmune diseases.
• State of immunodeficiency.
• Oncological diseases.
• Cirrhosis.
• Hypertension stage II and III.
• History of strokes, heart attacks, presence of a “pacemaker”.
• Endocrinopathies with clinical manifestations.
• Diabetes mellitus.
• Pregnancy.
• Epilepsy.
• Mental illnesses.
• Combination of several relative contraindications.

Relative contraindications:

• Chronic diseases in remission.
• Foci of chronic infections (dental caries, frontal sinusitis, sinusitis, tonsillitis, etc.).
• Menstruation.
• Psychopathy.
• Tendency to hypertrophic and keloid scars.
• Taking anticoagulants, fibrinolytics, antiplatelet agents.
• Decreased blood clotting.

Survey

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

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

The doctor is obliged to inform the patient about all acute moments related to the operation, indications, contraindications, complications and scars. Where the scars will be, what they should be, what needs to be done so that they do not become wider, more noticeable.

The patient, in turn, signs special documents in 2 copies at the initial appointment, in which he confirms his awareness. The documents come in two versions - "Informed consent" and "Agreement between the medical cosmetology center and the patient."

As a result, if any complication occurs, the patient will not be able to make a claim against the doctor that he was not informed about the complications and scars and demand material and moral compensation.

After the patient has undergone an examination, visited all specialists, received recommendations and, if necessary, drug therapy, detailed tissue preparation for surgery begins. And the postoperative period and, ultimately, the results of the operation will depend on how professionally competently this preparation was carried out.

It is advisable to allocate at least 1-1.5 months for preoperative preparation. Quite a large number of patients will be advised to lose excess weight before aesthetic plastic surgeries, and rapid weight loss can do more harm than good. It is advisable to leave at least 3-5 months for preoperative preparation and weight loss for such a contingent.

Cosmetic preparation of the patient before surgery

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

Oral treatment.

• vitamins C, A, E, group B;
• preparations and food supplements containing vitamins, silicon, potassium, magnesium, calcium, zinc, selenium (selmevit, zinctheral, alphabet, etc.):
• drugs to improve microcirculation (theonikol, andecalin, escusan 20, capilar);
• drugs that strengthen the vascular wall (ascorutin, etamsylate);
• immunomodulators (as indicated) - decaris, thymogen, imunofan, polyoxidonium, licopid, etc.;
• preparations containing essential fatty acids (evening primrose oil, linetol).

Antibiotic therapy. Some authors suggest using antibiotic therapy before plastic surgery and dermabrasion to prevent infectious complications (139). In 63% of cases, cephalosporin drugs are used, in 14% - dicloxacillin, in 6% - erythromycin. The course is 7-8 days. Other authors believe that preventive antibiotic therapy does not reduce the possibility of infectious complications, but can increase the body's resistance to the antibiotic used, allergenize the body and increase the colonization of Candida fungi.

Antiviral therapy. Surgeons and dermatosurgeons have long known about the risk of herpes infection in the postoperative period, after deep chemical peels and dermabrasion, especially in the perioral area. According to Perkins et al., 9.9% of patients with or without a history of herpes develop herpes infection after dermabrasion and chemical peels. For prevention, he suggests using 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 so that they can recover more easily after the operation, without suppuration, swelling and aesthetically unacceptable scars. What procedures should the cosmetology preparation of the patient before the operation consist of?

A course of peeling or dermabrasion is a necessary stage in the patient’s cosmetic preparation before surgery.

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

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

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

When working with peelings, it is necessary to know about side effects and complications (allergic reactions, hyperpigmentation, dyschromia, increased skin sensitivity) and to observe all the nuances of the technologies. It is imperative to use sun-protective, moisturizing, antioxidant creams containing tyrosinase inhibitors.

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

For patients who for some reason are not suitable for peeling, there is an alternative procedure - therapeutic dermabrasion (ultrasonic, sandblasting, oxygen). In order to achieve optimal renewal and smoothing of the stratum corneum, a course of procedures is carried out. Most often, procedures are performed once every 4-7 days, depending on the thickness of the epidermis layer removed per session, No. 5-7.

After completing a course of treatment with peels or dermabrasion, the patient is prescribed the following procedures, depending on his problems:

• Microcurrent therapy with programs for tissue restoration, myostimulation, lymphatic drainage, introduction of strengthening serums for a course of at least 15 sessions with an interval of every other day.
• Manual massage of the face, neck, décolleté, collar zone. The type of massage is not particularly important, you can prescribe therapeutic, plastic, point, etc. Its positive effect on skin microcirculation is important. lymphatic drainage, as well as a stimulating and tonic effect. One of the important properties of massage is its relaxing, anti-stress effect, beneficial effect on the central and autonomic nervous system. The course is prescribed - at least 10 procedures.
• Mesotherapy. Preparations are prescribed that have a biostimulating effect; improve metabolism, microcirculation in tissues, promote the stimulation of elastin and collagen production. Mesotherapy allows you to get the effect not only from the effect of pharmacological agents and needles on the skin, but also from the effect on biologically active points of the meridians of the gallbladder and urinary bladder, stomach, liver, small and large intestines. Normalization of the activity of these organs is one of the important conditions for the successful course 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 carried out (depending on the drugs used).
• Laser therapy. Red light therapy on paravertebral zones, biologically active points and directly on the skin in the area of future surgical intervention acts similarly to the above-described effects of mesotherapy. The course of treatment is 8-10 procedures.
• General massage of the body or back in the amount of 10-15 procedures. It is impossible to overestimate the role of such a course. Thanks to the massage, a general strengthening and tonic effect is exerted on the entire body as a whole and the skin in particular. Reflexively through the skin - on all internal organs and the central and autonomic nervous systems.
• Application of physical methods.
• Use of local products that moisturize, regenerate, improve microcirculation, and strengthen 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, and enhancement of their synthetic and proliferative activity. In addition, oxygen is destructive for the association of microbial flora living on the skin, especially for anaerobic microorganisms.

Taking all these factors into account, Auriga International (Belgium) created Chiroxy cream specifically for the purpose of improving tissue oxygen supply. The cream contains oxygen in nanosomes, which facilitate the passage of oxygen through skin lipids and deliver oxygen directly to the dermis.

Indications for use:

Chiroxy is indicated in the pre-peeling and pre-operative periods; in skin transplantation, ulcer treatment; to accelerate healing processes and prevent the formation of keloid scars. In the post-peeling and post-operative periods for the same processes. The use of the cream is especially relevant in patients with reduced reactivity of the body, with a tendency to prolonged inadequate inflammation; in people with a history of chronic diseases; in heavy smokers, patients with diabetes, atherosclerosis.

It is recommended to use it 15-20 days before the operation, twice a day, applying a thin layer to previously cleansed skin. Available in 50 ml plastic tubes.

To improve skin microcirculation, the domestic cream-gel Capilar, which contains cedar nut extract and ginkgo biloba extract, can be successfully used.

AuridermХО™ gel from Auriga International (Belgium) is a preparation whose main active ingredient is vitamin K1 oxide, which is located inside the nanosomes.

Indications for use.

It is a means of preventing and treating hemorrhages, edemas, hematomas, rosacea, stagnant erythema. Due to the presence of vitamins A, C and E, it has antioxidant and anti-inflammatory effects.

It is indicated as a means of preoperative preparation of patients before plastic surgeries and surgical dermabrasion.

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

Recommended for use to accelerate the resorption of postoperative hematomas and edema.

Produced:

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

Application:

Apply twice daily, morning and evening, by rubbing into the skin with light massaging movements. Injecting the gel with ultrasound enhances its effect.

All the listed procedures will act in the same way, causing improvement of microcirculation and lymphatic drainage in the skin, having a strengthening effect on the vessels and the body as a whole, on its immune system and adaptation mechanisms. Thus, preparation for surgical interventions is carried out, which is a system for preventing postoperative complications and pathological, aesthetically unacceptable scars.

When preparing patients for dermabrasion or deep chemical peels, it is recommended to treat the skin for a month:

Topical retinoids in the form of creams: 0.05% tretinoin cream, Radevit, Differin or professional cosmetics from ROC (France) containing retinoids.

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

• stimulate the migratory and mitotic activity of keratinocytes,
• stimulate the formation of a greater number of receptors for epidermal growth factor on fibroblasts,
• increase the synthesis of mucopolysaccharides, collagen, fibronectin by fibroblasts,
• 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 (AHAs) and glycolic acid, which has the smallest molecular weight:

• reduce the cohesion of corneocytes and, accordingly, 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 products restore the thickness of the dermis, its metabolism, vascularization, reduce the thickness of the stratum corneum and thicken the epidermis, which allows for optimal results after peeling and dermabrasion.

Use creams containing antioxidants that improve microcirculation and strengthen the vascular wall: Chiroxy, Auriderm, Capilar, Flavo-C serum (Auriga International, Belgium).

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