Care of patients after plastic surgery

Post-operative care of patients in aesthetic plastic surgery and dermatological surgery consists of the appointment:

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

It is necessary to begin procedures almost immediately after the operation to help the body cope with lymphostasis, ischemia, edema, hematomas and avoid inflammation. Physiotherapists recommend starting postoperative rehabilitation from the third day after surgery and using exclusively contactless methods until the seventh day, such as UFD, KUF, microwave, red therapeutic laser, magnetotherapy. 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 harmonious effect can be obtained on microcurrent devices. On the course - 10-15 sessions, every day you can start from the third day after the operation, very gently pointing to the skin. Procedures for working with scars on microcurrent devices are used, for example, the program ENTER on devices Bioterapuetic Komputer. Wadded cardboard sticks, moistened with a current-carrying 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 frequency from 20 to 50 MHz are used. The electric field of UHF causes vibrations of macromolecular components of connective tissue, which leads to increased tissue permeability and lymph drainage, improved microcirculation, and reduced hypoxia. Sessions are held daily or every other day for 10-15 minutes No. 8-10.

• Ultrahigh-frequency therapy (UHF).

High-frequency electromagnetic oscillations with frequency 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 to the postoperative area.

Ultrasonic vibrations with frequency from 880 to 3000 kHz are applied. Power - from 0.05 - 0.4 W / cm2 to 1.0 W / cm2. The therapeutic effect consists of 3 points: mechanical, thermal, physicochemical. For a pulsed mode, there is no thermal factor.

Due to the acceleration of the movement of biomolecules under the influence of ultrasound, metabolism in tissues is enhanced, the viscosity of the interstitial fluid decreases, tissue drainage increases, mucocirculation improves, hypoxia decreases. The procedure is carried out using a current-carrying gel, more efficiently using the gel "Lyoton-100" based on heparin or Auriderm XO ™ gels with Vitamin Kl, Chiroxy, capillar.

Directly on the area of postoperative sutures, ultrasound treatment is better not to be performed, as this can cause their insolvency, especially in places of increased functional load and in case of tendency to pathological scars.

We recommend 10-15 sessions, 10-15 minutes every other day or every day.

• Laser therapy.

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

Both radiations have a similar effect on tissues: they activate enzyme systems, cellular respiration, metabolism in tissues, synthetic and proliferative activity of fibroblasts, and reparative processes. Causes an expansion of the vessels of the microcirculatory bed and, as a consequence, lymph drainage, removal of hypoxia, improvement of excretion of decay products and free radicals from the operation zone. The wavelength ranges from 0.632 μm to 1.2 μm.

Points of application are the areas of operation, the corresponding paravertebral and segmental-reflexogenic zones. In addition, the therapeutic laser allows you to conduct laser puncture at a biologically active point.

Laser phoresis can be performed with the help of a semiconductor pulsed therapeutic laser on arsenite of helium (Helios-01) with a wavelength of 890-950 nm, pulse frequency from 300 to 3000 Hz and power up to 15 W. The duration of the session is 10 minutes. There are 10 procedures for the course. The number of courses is 3-5, with an interval of one month.

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

• Drug electrophoresis on the scars.

Immediately after epithelization of the wound surface, the following preparations can be used to improve the type of scars formed: potassium iodide with (-) poles, lidase (acidified solution 64-128ED from (+) poles), bee venom preparations - apizartron, apitoxin, apifor with (+ and -) poles. The current strength is sensed by the patient, the time is 15-15 minutes, for a course of 15-20 sessions every other day.

Drug electrophoresis can also be performed with microcurrents on microcurrent devices, with current up to 180 microamperes, and a frequency of 250-300 hertz on the iontophoresis program. The course of treatment - 10 - 15 procedures, every other day or every day. Number of courses 2-3, with an interval of 2-3 weeks.

With the appointment of procedures directly to the area of postoperative sutures, one must be cautious. In places where the skin near the scars and underlying tissues are subjected to stress and stretching, the loose tissue of the scar, after additional physiotherapy procedures, may be untenable and stretch. A wide scar on the site of the incision after plastic surgery can negate its results and lead to complaints from patients.

• Magnetotherapy.

Pulsed and low-frequency magnetotherapy is used.

Pulsed magnetotherapy causes the formation of vortex electric fields in tissues that induce electrical currents that induce vegetative fibers and cause contraction of smooth muscle vessels. As a result, trophic tissue, microcirculation and drainage are improved. Magnetic field inductors can be located permanently on the skin or move around the area of surgical intervention.

Low-frequency magnetotherapy causes a multidirectional movement of ions in tissues, resulting in increased metabolism in cells, which also leads to improved reparative processes, faster release of decay products and improved aesthetics of postoperative scars.

Use magnetic fields with induction 1,2-1,7 T

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

• Application of low- and mid-frequency electric currents.

D'arsonval.

D'arsonval is treated with weak impulse alternating currents of medium frequency and high voltage. Currents cause irritation of the free nerve endings in the skin, which leads to the reaction of the vascular bed with the improvement of microcirculation. Micronecroses arising in the skin under the influence of spark discharges lead to micro-scoping aseptic inflammation with the release of growth factors, cytokines, mediators of inflammation. Spark discharge also acts bactericidal on the flora of the skin.

The mushroom-shaped electrode is processed at average current parameters by all the skin in the operation zone on the 2-3rd day after the operation, alternating with other physiotherapy procedures daily or every other day, for a course of 8-10 sessions for 10-15 minutes.

• Bucca irradiation or close-focus X-ray therapy

If there is a tendency to the appearance of pathological scars, with a preventive purpose, immediately after the removal of the joints, one session of Bucca-irradiation should be done. 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 3-4 mm and act locally, causing a cytotoxic effect on cells with increased metabolism. In keloid scars, these are pathological giant fibroblasts. In addition, they act fibrinolytically on the young connective tissue (immature collagen fibers), so they can be successfully used in the treatment of already formed keloid scars.

• Ointment treatment.

Starting from 10-14 days, lubricate the postoperative sutures of solcoseryl, actovegin ointment, curiosin, chitosan gel, target-T, etc., 2 times a day, at least 2 months, it is desirable to alternate ointments. If there is a tendency to keloid or hypertrophic scars, postoperative sutures should be treated with contractubex, kelofibrease, lazonil, hydrocortisone ointment. In addition, treatment with film-forming varnishes, compression therapy (see treatment of keloid scars) is shown.

In the formation of hemorrhages, hematomas have an invaluable effect such drugs as Auriderm XO & trade, Chiroxy, capillar. Drugs should be applied to the skin 3-4 times a day or injected with phonophoresis.

Note:

• To an easy manual massage it is possible to proceed not earlier, than in 1,5 months after operation,
• The use of any masks is recommended not earlier than 2 months after the operation, as when they are removed from the face, skin may be stretched, which can lead to hemorrhage and a worsening of the appearance of scars.

[1], [2], [3]