Wound treatment that cures quickly and cleanly without pain

Nobuhiro Suetake *, Yukiko Morita *, Sachiko Kaji **
* Sakae Clinic
** Juntendo University School of Medicine Hospital Administration
Nobuhiro Suetake, MD *, Yukiko Morita, MD *, Tomoko Kajisa, MD **
* Sakae Clinic
** Department of Hospital Administration, Juntendo University School of Medicine

 

Even in recent advances in cosmetic surgery, the importance of wound care for suture wounds and surgical wounds has been rarely discussed. Cosmetic surgeons are required to have more knowledge and techniques about wound care than general surgery. In recent years, many wound dressings have been used, but the basic usage and techniques related to wound care will be discussed.
Platelet rich plasma (PRP) is a plasma in which platelets are concentrated by centrifugation, and the biological activities of various cytokines and growth factors released from platelets, and the tissue adhesion and wound covering effects of fibrin and platelet glue. Therefore, clinical application from the aspects of regenerative treatment and wound healing is being attempted. This time we report that we applied PRP therapy to wound care in cosmetic surgery and obtained good results.

Key words: gauze dressing, sterilization, moist wound healing, platelet rich plasma, wound dressing

 

Introduction

While cosmetic surgery has made remarkable progress in recent years, the importance of wound care in suture wounds and surgical wounds has not been discussed much. It seems that traditional surgeons perform wound treatment using traditional disinfection and gauze, but it is necessary to maintain a moist environment to heal the wound. Wet dressing therapy using materials has become mainstream. Since cosmetic surgeons are required to have more knowledge and skills about wound care than general surgeons, it is necessary to master wound treatment.

This time, we reviewed the conventional wound treatment, approached the new wound, and obtained good results. Based on the basic wound healing theory, we will discuss recent wound treatment methods with specific techniques. introduce.

 

Main issue

1) Wound healing theory

The basics of wound treatment are the same whether it is a trauma, postoperative suture wound, or trouble treatment such as postoperative infection or necrosis. If the wound healing process is compared to cell culture, it is necessary to maintain the moist environment by placing the cells in the culture medium when culturing the cells. It can be seen that the tissue fluid that plays is important and the wound must not be dried.

It is desirable to maintain the wound in a closed and moist environment if no infection is observed in the trauma or postoperative suture wound. The tissue fluid contains many cytokines and cell growth factors that promote wound healing (Figure 1. Wet therapy). Applying gauze directly to the wound is an act that impedes the wound healing process, as well as drying the wound. Traditionally, many surgical operations have applied gauze or sophraturing to suture wounds as a matter of course, but when considering the process of wound healing, these actions are meaningless, rather than meaningless. Will be delayed. In addition, dry gauze adheres to the wound surface, which is harmful because it causes bleeding and pain to the patient each time treatment is performed.

Even if it is a wound, the healing method differs between a suture wound and a skin defect wound. A suture wound is a controlled wound and undergoes a primary healing process. Immediately after the suturing, platelets are activated, various cytokines are released, and neutrophils and macrophages migrate to the wound with hemostasis. Epithelialization occurs within 48 time, and capillary growth occurs after 72 time (Figure 2. Suture wound healing process). Furthermore, skin defect wounds take different healing processes depending on the depth of the wound. In shallow skin defect wounds, epithelialization occurs from both the hair follicle and the skin at the wound edge, so healing is fast, but in deep skin defect wounds, granulation is formed and epithelialization occurs from surrounding skin, so it takes time to heal .

2) Disinfection Merits and Demerits

The state where the wound is infected (infection) is different from the state where bacteria are present in the wound (colonization).

Even if the wound appears to be small, Infection needs to be treated immediately. However, even if the wound is extensive, if it is colonized, treatment for infection is unnecessary and it is not necessary to disinfect. Whether or not the wound is infected is judged by the presence or absence of so-called four signs of inflammation (redness, pain, local heat, and swelling). In many cases, exudates or yellow necrotic substances are attached to the wound, but no infection has occurred, and appropriate diagnosis is important.

In principle, disinfection of suture wounds and necrotic surgical wounds is unnecessary. In order to prevent wound infection, drainage and debridement, which remove the source of infection such as necrotic tissue from the wound surface, are more important. Disinfection does not remove the source of infection, and disinfection does not prevent infection.

Also, disinfectants do not selectively sterilize bacteria. When human cells and bacteria are compared, the bacteria are covered with a capsule and may be more resistant to disinfection than human cells. Then, even if the wound is disinfected, the bacteria are not killed, but only human cells are damaged, and wound healing is delayed.

Disinfectants are not always useful for living organisms. There have been reports of cases of anaphylactic shock caused by the use of chlorhexidine (Hibiten®, Hexac®), and povidone iodine (Isodyne®) also has a high rate of contact dermatitis.

In particular, cosmetic surgeons should recognize that there is a risk of disinfecting the wound, and disinfecting the surgical wound after surgery should properly understand and consider the advantages and disadvantages of disinfection. Do not routinely disinfect suture wounds. Reasonless disinfection only results in delayed suture wound healing and pain to the patient. There are cosmetic surgeons who perform extensive disinfection on surgical wounds before suturing, but infection can be caused by the tissue damage of disinfection. Wound disinfection does not effectively prevent infection or promote wound healing.

 

Case

1) Introducing a case of ACR (Autologus Cell Rejuvenation) therapy, which is an active wound therapy. 62, female. A case of burns after hair loss treatment for hemorrhoids. The patient himself used a commercially available disinfectant to dry the spray wound, causing infection and forming an ulcer with 4X × 7㎝ necrosis.

First, ACR therapy was performed after debridement of necrotic tissue. 16ml of autologous blood was collected, centrifuged at 3000 for 8 minutes, and platelet-rich plasma (PRP: Platelet Rich Plasma) was prepared using a Regen kit (Figure 7, 8. PRP actual). The PRP 3cc created injected with needle 33G the wound bed section and the wound edge, and closed with bio inclusive? A wound dressing. 48 time closure therapy was performed, and the dressing was replaced on the third day after surgery. Thereafter, the wound contracted smoothly, and the wound was completely epithelialized on the 25 day after the operation.

During this time, bathing was performed as usual, and the wound surface was instructed to be washed thoroughly with shower every day after 3 days of treatment.

2) A case of suturing the incision of the upper eyelid. 26 years old, male. The stitched portion was covered with an alginate coating material cultstat and covered with an opsite polyurethane film dressing. The next day's wound does not show crust formation, and the wound edges are completely consistent. On the day of suture 5, epithelialization was completed after removal of the thread.

3) Case of re-operation of labia plastic surgery performed in another hospital (Figure 10. Case 3). 33, female. A cultist was placed on the sutured part after surgery. As a result, hemostasis from the wound becomes possible, and it immediately dissolves and the suture site becomes a moist environment. Patients were instructed to apply petrolatum to the wound every day to prevent drying. Bathing was possible from the next day, but there was no postoperative pain. After 1 weeks, the wound was completely epithelialized immediately after thread removal and no crust formation was observed.

 

Consideration

Platelet rich plasma (PRP) is a plasma in which platelets are concentrated by centrifugation, and the physiological activities of various cytokines and growth factors released from platelets, as well as the promotion of tissue adhesion and wound healing of fibrin and platelet glue. Expected to be effective. Platelets release various growth factors such as epidermal growth factor (EGF), transforming growth factor-beta (TGFβ), vascular endothelial growth factor (VEGF), and platelet-derived growth factor (PDGF) and many cytokines ( Figure 11.Network for wound healing). In PRP, platelets are concentrated about 2 to 6 times compared to peripheral blood, but leukocytes and various growth factors are also concentrated about 2 to 6 times, which may promote wound healing. Guessed. In addition to the physiological activity of platelet growth factor, PRP is expected to have hemostasis action by platelets, tissue adhesion action by fibrin / platelet glue, and skin scar suppression effect by anti-inflammatory effect. It is highly possible to apply. Previously, skin grafting had to be considered for the treatment of a wide range of skin necrosis such as case 1, but even with this PRP therapy, the wound was epithelialized and healed in a short period of time comparable to skin grafting. It becomes a treatment option. Similarly, the treatment of skin necrosis after surgery for armpit odors is not repeated sterilized or skin grafted, but if appropriate wound treatment is performed, there is almost no restriction on daily life for the patient and wound healing in a short period of time Is obtained.

Cultstat® used in cases 2 and 3 is a wound dressing made of alginate extracted from seaweed kombu and made into a nonwoven fabric. Alginic acid absorbs moisture that is 15 to 20 times its own weight, and gels when it absorbs water containing sodium ions such as leachate. This gel functions to maintain the moist environment of the wound surface. It is characterized by having a very strong hemostatic effect by releasing calcium ions during gelation. From these facts, it can be said that this covering material is suitable for treatment of wounds with bleeding other than surgical wounds. Effective hemostasis and wound healing can be obtained even if the dressing is difficult to operate, such as in this case. For a wound wound care, only an alginate coating material and a film dressing material are sufficient, and no gauze or sophratur is required.

Cosmetic surgeons should be aware that there are major errors in traditional care methods such as disinfection of sutures, gauze, and bath restrictions. It is necessary not only to train surgical techniques but also to take care of suture wounds. The point of care for surgical wounds that we consider is to perform appropriate drainage and compression so as not to create hematoma or dead space. It is also important not to disinfect the wound before suturing the skin and not to apply gauze or sophratur directly to the suture. Of course, the surgical wound after surgery is not disinfected, and after 48 time, the wound is washed and cleaned by bathing.

Recently, the thinking and methods related to wound treatment have changed completely, and there are many useful wound dressings, and it is necessary to become familiar with their usage. In the future, I hope that the correct wound treatment will become widespread and that more patients will benefit from it.

Methods of Wound Treatment in Cosmetic Surgery
English abstract (up to 200 words, 149 words)
Even with the remarkable strides made in cosmetic surgery in recent years, the importance of care for suture and surgical wounds has received little discussion.Cosmetic surgery requires greater knowledge and techniques for wound care than in general surgical procedures.Many wound-dressing materials have now come to be used; this discusses the fundamental usage methods and techniques of wound care.
Platelet-rich plasma (PRP) is an autologous concentration of platelets and growth factors, such as epidermal growth factor (EGF), transforming growth factor-beta (TGF-beta), vascular endothelial growth factor (VEGF), and platelet-derived growth Factor (PDGF). Increase of the wound repair rate by local application of a PRP solution has been reported.Its efficiency is proved in the domain of surgery, for treatment of severe burns and for the transplantation of cells and tissues.In this study, we applied this PRP treatment to wound healing in cosmetic surgery and great effectiveness was proven.

 

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