Toronto — Stem cells and lasers will likely become part of the armamentarium in woundcare, according to a professor of Dermatology at Boston University School of Medicine and director of the Dermatology Wound Clinic at Boston Medical Center, Boston.
Speaking here at the annual meeting of the Canadian Dermatology Association, Tania J. Phillips, M.D., F.R.C.P.C., covered pearls in woundcare, ranging from basic steps such as using tap water to cleanse wounds, to emerging therapeutic areas, such as cell therapies and light therapies for woundcare.
“If your tap water is drinkable, it’s OK to use it to clean wounds,” Dr. Phillips says.
In woundcare, as in other areas of medicine, there is concern about over use of antibiotics. Research suggests there is no advantage to using topical antibiotics such as bacitracin in surgical wounds. A study that compared the use of white petrolatum to bacitracin ointment in postoperative care showed infection rates were comparable between the two and white petrolatum carried minimal risk of producing contact dermatitis (Smack DP, Harrington AC, Dunn C, et al. JAMA. 1996;276(12):972-977).
Sutures and alternatives
Regarding sutures, Dr. Phillips cites a study that found no difference in cosmetic outcome when sutures were performed or not performed following a punch biopsy. It has been traditional practice to suture punch biopsies.
Investigators looked at 4 mm biopsies and 8 mm biopsies. Patients, however, expressed a preference for using sutures after an 8 mm biopsy was performed.
“It will save time and money, for you as well as the patients, if you don’t have to use sutures,” Dr. Phillips says.
Some alternatives to sutures include glues. Dr. Phillips says glues are particularly suitable in surgical wound closure for pediatric patients who have experienced traumatic lacerations.
“They take less time and are less painful,” she says.
An analysis of randomized, controlled trials in deep surgical wounds, however, found sutures were significantly better than tissue adhesives, producing less dehiscence and being significantly faster to use (Coulthard P, Esposito M, Worthington HV, et al. Cochrane Database Sys Rev. 2010;(5):CD004287).
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