Suturing is not always the best answer for closing a wound site, an expert says. Some newer materials may offer advantages over suturing and traditional protective antibiotic coverings for second-intention healing (SIH).
Dr. Kircik says a comparison study of bacitracin zinc 500 and polymyxin B sulfate versus trolamine/sodium alginate emulsion for SIH after Mohs micrographic surgery that showed the emulsion helped wounds heal faster and with fewer side effects. He is clinical associate professor of dermatology at Indiana University.
Dr. Kircik says the formation of scabs can slow the healing of the edges of the wound and may contribute to the growth of bacteria. SIH is optimized in a moist environment.
"This is a product that has been around Europe for a number of years, where it was used for treating radiation dermatitis," Dr. Kircik tells Dermatology Times.
In another study, Dr. Kircik looked at the use of the emulsion on shave biopsies and found that there was less erythema with the emulsion than with the antibiotic after three weeks of treatment.
"The trolamine/sodium alginate stimulates macrophage proliferation," Dr. Kircik says.
He says the emulsion offers two other major advantages over the use of topical antibiotics.
"Topical antibiotics are one of the most common causes of contact dermatitis. The water-based emulsion does not promote any allergic reaction.
"Another problem that is occurring because of the widespread use of antibiotics is the growing antibacterial resistance. We have more and more antibiotic-resistant infections; the more we can reduce the use of unnecessary antibiotics, the better it is," Dr. Kircik says.
Another topical wound-healing agent that offers unique properties is QR powder (Biolife).
"That is a hemostatic agent, so it stops the bleeding, but it also contributes to healing of the wound," Dr. Kircik says.
Dr. Kircik conducted a study comparing the efficacy of a topical hemostatic powder composed of potassium iron salt and a hydrophilic polymer to a foam sterile compressed sponge on Mohs surgical wounds.
No difference was shown in inflammation, swelling, infection, peeling, contact dermatitis, or hyper/hypopigmentation between the two groups, and both were safe and effective.
But there was a definite difference in healing. The results showed the hemostatic powder stopped the bleeding in 52.5 seconds versus 60 seconds for the sponge. Additionally, the group using the hemostatic powder showed a median decrease in wound size of 182 mm in 12 weeks versus 161.5 mm for the sponge grouping.
"Not only does the powder encourage a much shorter wound- healing time, we also saw less scarring," Dr. Kircik says.
The study results showed that after 12 weeks, 92 percent of the hemostatic powder group had no scarring versus 42 percent of the patients using sterile compressed sponge.
A new tool
Dr. Kircik says that in the arena of suturing, there is a new tool for surgeons. DermaClose RC, developed by Wound Care Technologies, is an external tissue expander.
According to Dr. Kircik, the device works very well for circular wounds.
"It's a new closure that is formed in a circle with staples. The stitches come out of the staple on the circle, so it helps close the wound much faster without doing a big flap or graft. That's the whole point, and it's really a cool thing, actually," Dr. Kircik says.
The company says the device helps large wounds close quickly, within days rather than weeks or months.
"It makes circular wounds shrink slowly, but surely. It's a simple gadget that's very cool," Dr. Kircik explains.
Disclosure: Dr. Kircik has received funding from OrthoNeutrogena as an investigator.