Prevention of scars

Prevention of scars in the broadest sense of the word can be called preoperative preparation of patients; correct and modern treatment of wounds, care for postoperative sutures, wound surfaces after peeling and operative dermabrasion.

Most often, wounds are encountered by surgeons - traumatologists, surgeons of polyclinics, kbobustiologists, ambulance doctors. Sometimes their main task is to save a person's life, rather than getting aesthetically perfect scars in the future. However, even such high tasks do not relieve doctors of a correctly performed wound revision, its treatment, the management of wound surfaces using modern wound coverings to obtain optimal scars and the application of the maximum possible cosmetic sutures.

In the case when it comes to receiving discreet scars after plastic surgery in aesthetic surgery, this direction takes a much broader character. To get the optimal result after an aesthetic operation means not only to eliminate the problem that the patient turned to a plastic surgeon, but also to get subtle scars at the skin incision site. It's 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 nullify the results of the most beautifully performed plastic surgery.

To no less important direction of the prevention of scars is the maintenance and treatment of wound surfaces after operative dermabrasion, deep peeling, electroexcision and cryodestruction of benign skin formations. Professionally correctly carried out cosmetological removal of benign skin formations, for example papilla, always results in non-scarring healing. However, quite often there are other results. Such disfiguring scars on the body of a young man - the result of illiterate removal of papilloma, a diameter of 1 mm and the same illiterate management of the wound surface. Well, the number of cicatricial complications after operative dermabrasion and deep peelings done to eliminate wrinkles exceeds all permissible standards and becomes a frequent subject of litigation.

Patients after medial peelings and therapeutic dermabrasion are also potentially dangerous because of the possibility of scarring. Therefore, doctors who deal with such procedures should be alert and competent in the issue of scarring. They are obliged to know the topic, methods of prevention and treatment of scars, modern wound covers, methods of treating wound surfaces. When joining the infection or reducing local reactivity, surface removal of the upper layers of the epidermis can result in extensive erosive foci, which may result in scars. Unfortunately, people with secondary medical education and doctors who do not have specialization in dermatology and cosmetology consider it possible to deal with such manipulations. It's so easy! Yes, it is possible to teach a housewife to apply a peeling solution to the skin or work on a cosmetology device, but she will not be able to treat the skin, nor can she prevent the appearance of complications. This is one of the reasons why it is unacceptable to engage in cosmetology physiotherapists who are not dermatologists, and therefore not knowing dermatocosmetology, they begin to deal with it under the brand of "hardware cosmetology."

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

Complications after plastic and aesthetic operations

• Hematomas

Are formed because of:

• increased fragility of blood vessels.
• pathology in the blood coagulation system.
• reception of anticoagulants, fibrinolytics, antiaggregants.
• increase of blood pressure.
• patient's non-compliance with postoperative treatment

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

• Edema

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

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

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

• Accession of secondary infection

Accession of the association of pyogenic flora translates adequate inflammation into the septic with the appearance of an extensive zone of erythema, edema, purulent discharge from the area of the postoperative wound.

Treatment: broad-spectrum antibiotics, topical antiseptic solutions and ointments, wound drainage, modern wound covers.

• Necrosis

Necrosis is one of the most dangerous complications. They can be caused by obliteration of the main vessel, a violation of innervation, associated with a strong tension of the tissues and a violation of their microcirculation. In addition, they can be associated with tissue swelling (microcirculation disorders), with reduced local and general immunological reactivity of the patient. On the site of tissue necrosis, wounds remain, and subsequently wide scars.

Treatment: removal of dead and ischemic tissues, antiseptic treatment of the wound with the imposition of modern moisturizing wound coatings based on hyaluronic acid or collagen with antibiotics.

• Skin and allergic reactions

1. Skin-allergic reactions of delayed type

Allergic contact dermatitis. Occurs in the form of delayed-type hypersensitivity. When repeated contact with the allergen (AHD, chlorhexedin, iodinol, etc.) for 48-72 hours develops an inflammatory reaction in the erythematous or vesiculoid form. Especially dramatic is the appearance of such, at first glance, unexpected complication after a perfectly performed operation. In the area of exposure to the allergen, inflammatory mediators are isolated and a clinical picture of allergic dermatitis is developed, which can lead either to insufficiency of the joints and expansion of the destruction zone, or to deepening the wound surface after dermabrasion, secondary infection, prolonged inflammation and scarring.

Treatment: removal of a possible allergen by saline washing, antihistamines inside and outside, lotions. Corticosteroid preparations containing antibiotics in the form of aerosols. An example of such means are aerosols "Oxicort" and "Polcortolon TS" (Poland).

Aerosol Oxycorte (55 ml) contains active ingredients: hydrocortisone acetate 0.1 g and oxytetracycline hydrochloride 0.3 g; aerosol "Polcortolone TC" (30 ml) - triamcinolone acetonide 0.01 g and tetracycline hydrochloride 0.4 g. Hydrocortisone acetate refers to corticosteroids of weak activity, which makes it safe to use it for extensive lesions and in particularly sensitive areas of the skin. Triamcinolone acetonide, contained in the aerosol "Polcortolone TS", refers to hormones with a moderate strength of action and is more often used in severe forms of dermatoses and deep focal lesions. Spectrum of bacteriostatic action of aerosols Oxicort and Polcortolone TC: bacteria Gram (+) - Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pyogenus. Streptococcus pneumoniae, Clostridium sp., Enterococcus faeealis, Propionibacterium sp .; bacteria Gram (-) - Haemophilus sp., Neisseria meningitidis, Klebsiella sp., Proteusmirabilis, Moraxella catarrhalis, Pseudomonas sp., Escherichia coli. Auxiliary substance - gas Drivosol 35 (Span 85, lecithin, isopropyl myristate, a mixture of propane and butane) has drying, anesthetic and cooling effects on evaporation from the skin surface.

Aerosols "Oxycorte" and "Polcortolone TC" are effective agents for the treatment of patients with contact dermatitis, burns and frostbite of I and II degrees.

Drugs can be given to patients after operative dermabrasion, recommended for use at home in the treatment of dermatitis, staphylo-streptoderma; removal of the inflammatory reaction after plastic surgery, peeling.

Aerosols "Oxycorte" and "Polcortolone TC" are recommended to spray over the affected skin 2-4 times a day at the same intervals.

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

After removing the severity of the process, corticosteroid ointments (hydrocortisone, celostoderm, synaflan, sinolar, triderm, advantan, etc.) are prescribed.

The drug Advantan (methylprednisolone aceponate, a non-halogenated synthetic steroid, the representative of the latest modern class of corticosteroid hormones for topical application) is a drug of alternative choice 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 - the appointment of antihistamines per os.

2. Skin-allergic reactions of immediate type (anaphylactic)

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

Treatment: inside antihistamines (claritin, kestin, telphrast, cetrine, etc.). Corticosteroids (prednisolone, dexomethasone), sodium thiosulfate intravenously or intramuscularly.

External: removal of a possible allergen by saline washing, aerosols (oxycorte, polcortolone TS).

Expansion of the scarring zone after aesthetic plastic surgery.

• the appearance of scars after operative dermabrasion for skin revitalization.
• the formation of significantly noticeable scars in places of incisions.
• formation of keloid and heptrophic scars.

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