The importance of sound wound-healing techniques cannot be overestimated in the practice of dermatology. Patients desire treatments that heal scarring and wounds effectively but that don't require long periods of treatment and recovery time. Sometimes that's a challenge, and top practitioners are seeking ways to meet it.
Susan Weinkle, M.D., runs a practice in Bradenton, Fla., and is assistant clinical professor of dermatology at the University of South Florida College of Medicine in Tampa. Her specialty is Mohs surgery, about which she lectures frequently both as a speaker and in her academic role.
"In my practice, wounds are closed at the time of surgery primarily or some may require either a skin graft or flaps," she says. "I use Vicryl sutures, which are commonly used in layered closures, though sometimes instead of absorbing the sutures, the body has the opposite reaction and wants to expel them. When this happens, the Vicryl suture has to be removed and you are left with a low-grade wound that has to be repaired."
Dr. Weinkle says a new topical cream product available to physicians has proved very effective in helping heal such wounds in her patients.
"It's called Biafine, and I've found that it helps stimulate and speed up the healing process," she says. "I think it's an exciting new advent in wound-healing treatment, and a less-powerful version of it is in the process of being approved by the Food and Drug Administration for prescription use."
Dr. Weinkle adds that pharmaceutical companies are also developing new kinds of postsurgery dressings.
"There are some new kinds of liquid bandages that have been developed and are effective in helping to expedite wound healing, but these are for use with dry wounds as opposed to oozing wounds," she elaborates. "There have also been some developments in collagen bandages that stimulate epidermal growth and thus serve to increase healing in open wounds."
Dr. Weinkle says another more frequently used wound-healing procedure is hyperbolic oxygenation chambers - and that she refers patients to such facilities regularly.
"These chambers increase the amount of oxygen to the area where the wound-healing needs to occur, obviously hastening the healing process, so they're very effective - but there isn't anything new in the area of hyperbolic oxygenation," she says.
When less is better
As for flap techniques and configurations, Dr. Weinkle says there is a wide variety of them - but that it's crucial for doctors to remember one significant point.
"Always keep in mind that less is better, especially where facial procedures are concerned," she advises. "You can use all types of techniques, but the key is to prevent distortion in the least invasive way possible."
Dr. Weinkle says that it's also crucial for doctors to remember that if a hematoma does form as the result of a procedure, it must be expressed or evacuated to decrease the possibility of infection.
"No matter how beautiful the surgery appears to be at first, post-operative wound-healing care - including the ointment applied - is crucial to an outstanding outcome," Dr. Weinkle says. "It's also crucial that surgeons understand that the person doing the prepping and the bandaging can really make a big difference in the outcome. They must be well-trained in what they're doing - and you'd be surprised how many doctors don't seem to understand this detail."
Lasers improve appearance
One of Dr. Weinkle's Florida-based colleagues is Keyvan Nouri, M.D., associate professor of dermatology and otolaryngology and director of dermatologic surgery at the University of Miami's Miller School of Medicine. Dr. Nouri advocates the application of pulsed dye laser treatment (PDL) for wound healing in appropriate cases.