Not all wounds are created equal

September 1, 2004

Victoria, British Columbia - While dermatologic surgeons are very aware and do an excellent job in managing wounds, wound healing is an area that needs the supervision and expertise of a trained practitioner, according to Gordon E. Searles, O.D., M.D., MSc, FRCPC, FRCPC, FACP. Speaking at the Canadian Dermatology Association Annual Conference, Dr. Searles compared the traditional training surrounding the management of "cold steel" wounds with those that occur as a result of lasers, and the importance of understanding the difference.

Victoria, British Columbia - While dermatologic surgeons are very aware and do an excellent job in managing wounds, wound healing is an area that needs the supervision and expertise of a trained practitioner, according to Gordon E. Searles, O.D., M.D., MSc, FRCPC, FRCPC, FACP. Speaking at the Canadian Dermatology Association Annual Conference, Dr. Searles compared the traditional training surrounding the management of "cold steel" wounds with those that occur as a result of lasers, and the importance of understanding the difference.

"For those patients who have dermatologic surgery, the wound is acute, however, the modalities we're using (to manage the wound) are different than the traditional methods that are taught for the surgeons who are using cold steel," says Dr. Searles, clinical associate professor, division of dermatology and cutaneous medicine, department of medicine of the University of Alberta. "A lot of our modalities involve lasers - the biophysical effects of lasers on the skin are not the same as cold steel excisions. We need to make certain that the dermatologic surgeon is aware of what's happening to the skin."

Cold steel vs. heat infused A wound caused by a laser's heat is more complicated than an injury caused from fire. The dermatologic surgeon alters the cutaneous vasculature with some types of laser therapies, therefore altering the blood vessel supply and how the skin will heal.

While lasers are used to help diminish scars from previous wounds, such as nonablative lasers for the treatment of acne scars and ablative lasers like CO2 and erbium for shallow scars, the lasers themselves can also be the source of significant wounds in certain patients.

The dermatologic surgeon will want to avoid cellulitis or impetigo within a wound because these can impact the healing process. Additional risks are presented when reaching into an oral cavity or the nose, with the mucous membranes presenting a danger of bacteria feeding into the bloodstream, according to Dr. Searles.

Proper care for today's wounds "There are many types of dressings that can keep the wound warm and protected from injury, while capturing and donating the wound fluid near the wound surface. This fluid contains many of the growth factors and inflammatory cells that are responsible for proper healing," Dr. Searles says.

Often the dermatologic surgeon will apply topical antibiotics and agents to aid the wound healing process, but these can be potential allergens, he adds.

"Frequent washing or debridement is also discouraged - you should encourage the patient to leave the skin alone," Dr. Searles cautions.

"For those procedures done in cosmetically obvious areas, we should use something that's not too bulky and is cosmetically pleasing."

Examples of this are thin hydrocolloid sheets, or thin flexible foam dressings.