Scar prevention

Scar prevention in the broad sense of the word can be called preoperative preparation of patients; correct and modern treatment of wounds, care of postoperative sutures, wound surfaces after peeling and surgical dermabrasion.

Most often, surgeons - traumatologists, polyclinic surgeons, combustiologists, emergency doctors deal with wounds. Sometimes their main task is to save a person's life, and not to obtain aesthetically impeccable scars in the future. However, even such high tasks do not relieve doctors from a competently performed revision of the wound, its treatment, management of wound surfaces using modern wound dressings to obtain optimal scars and the imposition of the most possible cosmetic sutures.

In the case when it comes to getting invisible scars after plastic surgery in aesthetic surgery, this direction takes on a much broader character. Getting an optimal result after an aesthetic surgery means not only eliminating the problem with which the patient turned to the plastic surgeon, but also getting barely noticeable scars at the site of the skin incision. It is no secret that scars formed by patients after plastic surgery often cause the greatest psychological discomfort in patients. Not to mention the fact that rough scars negate the results of the most perfectly performed plastic surgery.

An equally important area of scar prevention is the management and treatment of wound surfaces after surgical dermabrasion, deep peeling, electroexcision and cryodestruction of benign skin lesions. Professionally competently performed cosmetological removal of benign skin lesions, such as papillomas, always ends with scarless healing. However, other results are quite common. Such disfiguring scars on the body of a young man are the result of illiterate removal of a papilloma, 1 mm in diameter, and the same illiterate management of the wound surface. Well, the number of cicatricial complications after surgical dermabrasion and deep peelings done to eliminate wrinkles exceeds all acceptable standards and becomes a frequent subject of litigation.

Patients after medium peelings and therapeutic dermabrasion are also potentially dangerous due to the possibility of cicatricial complications. Therefore, doctors who perform such procedures should be alert and competent in the issue of scar formation. They must know the topic, methods of prevention and treatment of scars, modern wound dressings, methods of treating wound surfaces. If an infection occurs or local reactivity decreases, superficial removal of the upper layers of the epidermis can result in extensive erosive lesions, which can result in scars. Unfortunately, people with secondary medical education and doctors who do not specialize in dermatology and cosmetology consider it possible to perform such manipulations. It's so simple! Yes, a housewife can be taught to apply a peeling solution to the skin or work on a cosmetology device, but she will not be able to treat the skin, just as she will not be able to prevent complications. This is one of the reasons why it is unacceptable for physiotherapists to engage in cosmetology; they are not dermatologists and therefore do not know dermatocosmetology and begin to practice it under the brand of “hardware cosmetology”.

One of the areas of scar prevention is the prevention of postoperative complications, since complications can cause an expansion of the skin destruction zone and additional scarring.

Complications after plastic and aesthetic surgeries

• Hematomas

They are formed due to:

• increased fragility of blood vessels.
• pathologies in the blood coagulation system.
• taking anticoagulants, fibrinolytics, antiplatelet agents.
• increased blood pressure.
• failure of the patient to comply with the postoperative regimen

Treatment: evacuation of the hematoma and, if necessary, revision of the wound with hemostasis, prescription of antibiotics.

• Edema

Depending on the degree of severity of edema, they can be interpreted as physiological (weak, moderate) and strong, which can lead to pathological changes in tissues due to their hypoxia. As a rule, with good preoperative preparation of patients, this complication is absent.

Treatment: cold, diuretics, antioxidant drugs, drugs that improve microcirculation and strengthen the vascular wall.

Physiotherapeutic procedures: ultrasound, magnetic laser therapy, lymphatic drainage procedures, etc.

• Secondary infection

The addition of a purulent flora association transforms adequate inflammation into septic inflammation with the appearance of an extensive zone of erythema, edema, and purulent discharge from the area of the postoperative wound.

Treatment: broad-spectrum antibiotics, local antiseptic solutions and ointments, wound drainage, modern wound dressings.

• Necrosis

One of the most dangerous complications is necrosis. It can be caused by obliteration of the main vessel, disruption of innervation, associated with strong tissue tension and disruption of their microcirculation. In addition, they can be associated with tissue edema (disruption of microcirculation), with reduced local and general immunological reactivity of the patient. Wounds remain at the site of tissue necrosis, and subsequently wide scars.

Treatment: removal of dead and ischemic tissue, antiseptic treatment of the wound with the application of modern moisturizing wound dressings based on hyaluronic acid or collagen with antibiotics.

• Skin allergic reactions

1. Delayed-type skin allergic reactions

Allergic contact dermatitis. Occurs as delayed-type hypersensitivity. Upon repeated contact with the allergen (AHD, chlorhexidine, iodinol, etc.) within 48-72 hours, an inflammatory reaction develops in an erythematous or vesicular form. The appearance of such, at first glance, unexpected complication after a perfectly performed operation looks especially dramatic. Inflammatory mediators are released in the area of the allergen impact and a clinical picture of allergic dermatitis develops, which can lead either to suture failure and expansion of the destruction zone, or to deepening of the wound surface after dermabrasion, secondary infection, prolonged inflammation and scarring.

Treatment: removal of possible allergen by washing with saline, antihistamines internally and externally, lotions. Corticosteroids, antibiotic-containing preparations in the form of aerosols. Examples of such products are aerosols "Oxycort" and "Polcortolone TS" (Poland).

Aerosol "Oxycort" (55 ml) contains active ingredients: hydrocortisone acetate 0.1 g and oxytetracycline hydrochloride 0.3 g; aerosol "Polcortolone TS" (30 ml) - triamcinolone acetonide 0.01 g and tetracycline hydrochloride 0.4 g. Hydrocortisone acetate is a weak-activity corticosteroid, which allows it to be safely used for extensive lesions and in particularly sensitive areas of the skin. Triamcinolone acetonide contained in the aerosol "Polcortolone TS" is a moderate-strength hormone and is more often used for severe forms of dermatoses and deep focal lesions. The spectrum of bacteriostatic action of Oxycort and Polcortolone TS aerosols: gram-positive bacteria (+) - Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pyogenus. Streptococcus pneumoniae, Clostridium sp., Enterococcus faeealis, Propionibacterium sp.; gram-positive bacteria (-) - Haemophilus sp., Neisseria meningitidis, Klebsiella sp., Proteus mirabilis, Moraxella catarrhalis, Pseudomonas sp., Escherichia coli. Excipient - Drivosol 35 gas (Span 85, lecithin, isopropyl myristate, propane and butane mixture) has a drying, anesthetic and cooling effect when evaporated from the skin surface.

Aerosols "Oxycort" and "Polcortolone TS" are effective means for treating patients with contact dermatitis, burns and frostbite of the first and second degree.

The preparations can be prescribed to patients after surgical dermabrasion, recommended for use at home in the treatment of dermatitis, staphylo-streptoderma; removal of the inflammatory reaction after plastic surgery, peelings.

It is recommended to spray Oxycort and Polcortolone TS aerosols over the affected skin 2-4 times a day at equal intervals.

The duration of therapy is determined individually and is on average 3-7 days. With short-term use and when applied to small areas of the skin surface, the drugs do not cause side effects.

After the acute stage of the process has subsided, corticosteroid ointments are prescribed (hydrocortisone, celestoderm, sinaflan, sinolar, triderm, advantan, etc.).

The drug Advantan (methylprednisolone aceponate, a non-halogenated synthetic steroid, a representative of the latest modern class of corticosteroid hormones for topical use) is an alternative drug to traditional halogenated corticosteroids. Being a highly lipophilic substance, it is able to quickly penetrate the epidermis into the dermis and have a therapeutic effect. If necessary, prescribe antihistamines per os.

2. Immediate-type allergic skin reactions (anaphylactic)

A general allergic reaction may manifest itself as urticaria, Quincke's edema, and anaphylactic shock. A local anaphylactic reaction occurs with skin swelling, blisters, and itching.

Treatment: antihistamines taken orally (claritin, kestin, telfast, cetrin, etc.), corticosteroids (prednisolone, dexamethasone), sodium thiosulfate intravenously or intramuscularly.

Externally: removal of possible allergen by rinsing with saline solution, aerosols (oxycort, polcortolone TS).

Expansion of the scarring zone after aesthetic plastic surgery.

• the appearance of scars after surgical dermabrasion for skin revitalization.
• formation of significantly visible scars at the incision sites.
• formation of keloid and hypertrophic scars.

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