Post-operative wound management and ongoing treatment and protection of the skin
1.Currently both at home and abroad, some doctor employ the traditional dressing or surgical dressing which is semipermeable and postoperative-symptom-relieving biosynthesis. Namely, enclosed method. While some other doctors simply use topical ointment of antibiotics, which called open therapy. Whatever the means are, it should take use of the dressing which is good in absorption of the drainage and in moisturizing, so that it could heal the wound in short time and relieve the postoperative pain. Mostly, we choose the postoperative treatment method according to specific situations.
2. According to the grinding degree (range, depth), oral antibiotics could be suggested to protect infection. If the patients with history of herpes simplex, in general, effective medicine of antivirus infection should be applied, which is keep on taking from preoperative 24 hours to postoperative 7-10 days, until the healing of epidermis. Most patients have no postoperative pain or slight pain, general painkillers, like cortisone (20-30mm/once a day for 3-5days) could be suggested to take orally to relieve the edema after operation, especially for those who have a widespread surgery. Caution in using the hormone medicines when the patient has a tendency of virus infection. For most patients, an icepack will have a wonderful performance on easing the topical symptom, edema and effusion, especially on wound of widespread surgery.
3.For the postoperation, we generally use a special surgical dressing, 2nd skin, to treat the large area of wound, which has good absorption of exudates, and maintain the moist wound environment without causing tissue impregnation. Twice a day for the first three days and later once a day. Open the wound area on 5th-7th days and coated with compound Chinese herbal ointment with their configuration for more than two weeks, generally. The exchange time of those given methods of wound healing should be based on the speed of each patient so as to make an appropriate adjustment，which also related to each doctor’s clinic experience. In this way, the wound scar is not obvious and the changes of wound color are very smooth. However, it is not suitable for smaller wounds or closure therapy. We more directly use Chinese herbal ointment which should be thickly coated, initially. After 2 to 3 weeks, you can see a small amount of scarring, and then continue to use the ointment 1 to 2 weeks until the scar off completely.
4.Once the scar off the wound, without obvious inflammation and pigmentation, you can use some light-shade liquid and cosmetics. For those post-inflammatory hyperpigmentation(within one month after surgery) patients, we often use hydrocortisone cream with glycolic acid or retinoic acid accompanied by a small amount of compound hydrocortisone preparation. Most patients can recover within 1 to 2 months. If the patient is allergic to hydroquinone, retinoic acid, or azelaic acid, you can use the desensitization therapy or use other type of drugs. You should minimize the possibility of second inflammatory pigmentation. It is an essential part in our clinic practice, and that is why we have your special attention. Although the pigmentation is temporary, which can itself go away, the use of hydroquinone cream, UV protection will dissipated this phenomenon as soon as possible.
5.Using pulsed CO2 laser to grind skin, the side effect is not common, but postoperative erythema, which typically lasts 6 to 12 weeks, should not be treated as a complication, such as long erythema duration or local skin hardening probable means early scars. Milium and acne can occur, esp. when you use some oil-gas-tight ointment after surgery. Using some retinoic acid medicine may help you to reduce or remove milium, local use or eat some oral antibiotics can control wound infection and it is also helpful to treat acne.
6.In any surgical procedure, infection can lead to complications which you should do bacterial culture and take the broad-spectrum oral antibiotics. If the patient has a history of herpes simplex infection may easily have wound infection, you’d better use some drugs to prevent and do more local wound care, similarly, wound infection can also localized use topical antiviral agents. For those who just started to take the retinoic acid drugs right before operation, you should give some advice and explanation by routine. For those who are taking can be allowed before surgery, but at the first stage of post operation, patients can not take in order to avoid excessive stimulation.
7.Using any kind of grinding technology will appear scar if the doctor can not grasp the depth of intraoperative grinding, which, in some way, will damage the dermis layer. In addition, for those who take retinoic acid drugs recently, or postoperative patients with secondary wound infection will increase the risk of scar.
8.Generally speaking, dark-shade is necessary at the following 3rd to 6th months after the required time, because ultraviolet light may lead to irregular pigment changes in the process of wound healing. Opaque shading materials (including titanium dioxide, etc.) are perfect basic supplies, which play dual roles in shelter and light-shade. Most patients are unwilling to back to their daily life until the surgical part can be covered by makeup and the swelling is fully subsided (often more than ten days). And normally, the patient should come back to the clinic to have a postoperative review at 1st, 3rd, 4th and 8th weeks, take and leave photos.
