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Wound care is a significant problem to dermatologists who perform abrasive cosmetic procedures such as dermabrasion, CO2 laser treatment or chemical peeling, according to Henry H. Roenigk, M.D.
"We have to make the patient comfortable and get the wound to heal better," Dr. Roenigk says. "Moist dressings are very effective in getting clean wounds to heal rapidly." Special dressings are not needed for minor abrasions or wounds from simple excisions or punch biopsies, he adds.
A board certified dermatologist, Dr. Roenigk performs a variety of cosmetic procedures at Arizona Advanced Dermatology in Phoenix. He has used moist dressings for 15 years.
"If we do a full-face laser or dermabrasion, we get an open wound over the whole face that could get infected," he says. "Patients are uncomfortable when the air gets to it, so we use artificial moist dressings such as Vigilon (Bard Medical Division) or 2nd Skin (Spenco Medical Corporation). These are gel preparations that provide moisture to the wound and absorb discharge. We generally change these dressings every day until the wound is healed."
For example, at one time, dermatologists used no dressings after dermabrasion to treat acne scars, according to Dr. Roenigk.
"We left the wound open to the air, let it scab over, and patients were miserable with pain," he says. "Today, we apply the 2nd Skin or Vigilon and the patient is much more comfortable. There is less chance of infection, fewer problems with scarring, and generally faster healing."
Moist dressings also have drawbacks.
"They are hard to apply sometimes, especially on the face," Dr. Roenigk says. "They don't adhere to the wound well and have to be held in place with tape or gauze. Some reports say there is more risk of infection than with dry wounds, but I have not found that to be the case."
When moist dressings are used, healing requires only three to four days, according to Dr. Roenigk.
"If we allow the wound to dry (rather than apply a moist dressing), it heals, but it takes awhile for the scab to come off," he says. "The scab forms in two to three days and stays on for five or six days before it comes off, so we are talking nearly 10 days. With 2nd Skin, wounds heal in about five days, cutting the healing time in half." Dr. Roenigk applies moist dressings for three days with laser resurfacing and for five days with dermabrasion.
Moist dressings should be changed each day until the wound heals, Dr. Roenigk says.
"When I do a dermabrasion, I take the dressing off every day, clean the wound, and then apply another moist dressing. The patient has to come back to my office daily."
Depending on the size of the wound and the patient's confidence, Dr. Roenigk may allow the patient to change the dressing at home.
"For the most part, with the cosmetic procedures, we have the patients come into the office and we do it here," he says.
Dr. Roenigk also uses moist dressings for leg ulcers.
"Once the infection is cleared up and the wound has good granulation tissue, we frequently use 2nd Skin or Vigilon to get good skin to grow over the ulcer," he says. "But we must clear up the infection first. A dermabrasion or CO2 laser wound is basically a clean wound, whereas a leg ulcer is frequently infected."
Disclosure: Dr. Roenigk has no financial interest in wound care products.
For more information:
Rovee DT. The Epidermis in Wound Healing. Boca Raton, Fla: CRC Press; 2003.