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Know About Ulcers Blog


Have you recently had surgery? If the
answer is yes, you might find useful this presentation about wound healing and
scar care. First of all, you should know that wound healing doesn’t finish when you may
think. In fact, wound healing is a complex and dynamic process in which three phases
have been identified. The first is the inflammatory phase. It lasts about
three days and overlaps with the second phase, the proliferative phase. It’s in this
second phase when the deposition of the fibers, essentially collagen, that will make
up the scar starts, and when the contraction of the scar, more or less discrete depending on the
characteristics of the skin will take place. One month after surgery we can
appreciate more or less the appearance that the final scar will exhibit, but
this scar remodeling is an ongoing process that takes up to one year to
finish, this is when the maturation, the third phase takes place. As a consequence,
if you want to have better cosmetic results, this implies that you can do
something by managing well your scar all this time. Where’s your scar located? This is important
and depending on the location your doctor may give you different
instructions. Always follow the recommendations. Location is relevant. It’s not the same
a wound located on the back than on the face. It’s completely different and this means
different ways of proceeding. For example, a wound located on the back is under a lot of tension. We have very potent and strong muscles here, so this wounds
are more prone to dehiscence and leave wider scars. Dehiscence means the opening of
the wound along the surgical incision. This happens if you move too much the
operated region or the wound becomes infected. So always follow the
instructions of your doctor and nurse. They may tell you not to move the region
for a few days, elevating the leg if the surgical wound is at this level, etcetera. That will depend on the characteristics of the wound and the surgical procedure,
but as a general recommendation don’t move the operated region the
first three to five days after surgery when the risk of dehiscence is higher.
There are many other factors that you should take into account because they can
have an impact on the final scar or they can interfere with the normal
wound healing process. The final scar will depend of course on
the size of the wound. This is obvious. The bigger the wound, the bigger the scar. But it also
depends as I explained earlier on the location, and there is another factor to
consider which is the patient’s age. This is interesting in two ways. On the one hand,
it is well known that in elderly people we can perform a complicated surgery on the face
with a huge scar in the beginning, but after a few months the improvement is dramatic
and finally after a few years, the cosmetic appearance of the final scar
is amazing. This is due to the laxity of the skin in this population group,
the loose tissue contracts more, so the final size of the scar is smaller than
it would have been in a younger individual. On the other hand, we know that with
aging, the ability of our tissues to repair is lower, so the elderly are more
susceptible to poor wound healing, infections, wound dehiscence and chronic ulcers. Some drugs inhibit cell division delaying wound healing and contraction. Your
doctor will tell you about this, but ask if you have any doubts. For the same
reason, there are illnesses that compromise wound healing, like diabetes
mellitus. Diabetes is a multi systemic disorder that compromise the
irrigation and innervation of the wound. If you’re diabetic, your wounds will require
special care and tightly control of your blood sugar. If not, the risk of dehiscence
and infection are high. Radiation therapy is used in many types of cancers and
also interferes with the normal wound healing process. Psychological or
physical stress also compromise wound healing. The basic explanation is that
under stress the sympathetic nervous system is stimulated. This is the part
of our autonomic nervous system which is activated in emergency situations, for
example, if you are running for your life because a lion is chasing you, then this system is activated. This is known as
the flight or fight response. In this case, blood to the skin is not as
necessary that, for example, to the muscles, so the small blood vessels in
the skin become narrower – this is known as “vasoconstriction”. If you have a wound that
is not properly irrigated, it doesn’t receive then the nutrients and cells necessary to heal properly. Nicotine in cigarettes has a similar effect, it is
a potent vasoconstrictor, so it also interferes with normal wound healing. Your surgeon
will normally recommend to stop smoking four- six weeks before the surgery. You should do it, and for good, it is well
demonstrated its negative effects on wound healing. For example, it’s been
established that the risk of wound infection is clearly higher in smokers than in non smokers. This is also obvious. Nutrition. In essence, if the person
is not correctly nourished, the ability of tissue repairing is also compromised. And
finally, if the wound is infected, the normal stages of wound healing will not
take place, the wound will open and it will cure by second intention, with probably a worse aesthetic result. These are most of the
exogenous and endogenous factors affecting wound healing. What do you have to do
if you see that your scar is growing abnormally? In this case, you should
immediately seek advice from your doctor. These are complications and sometimes
they require special management. Hypertrophic scars tend to appear soon
after surgery and can solve spontaneously, but keloids are more
complicated. While hypertrophic scars grow
within the borders of the wound, keloids go beyond them and can appear as late as a year
after surgery – until the third and last phase of wound healing – the maturation phase -is
completed. Factors that have been associated with a higuer risk of hypertrophic scars/ keloids are: Dark skin, certain
locations (presternal, deltoid, the earlobes…) and wounds that cross skin tension lines, closing wounds under tension. So what can you do to take care of your
wound and your scar? After surgery you will follow the recommendations
given by your doctor. The way of managing a wound depends on the characteristics of it. But
general recommendations are that you keep it clean, washing it every day and drying it
gently and applying an antiseptic like clorhexidine or povidone-iodine. It’s
been also demonstrated that wounds heal better in a moist environment, so the
first few days you may apply an ointment like petroleum jelly and cover the wound with
an occlusive or semi-occlusive dressing. And as I explained earlier, you
have to avoid moving the operated region a lot, or you should have your legs
elevated in case of surgery at this level. In any case, I repeat, these are
general recommendations to avoid dehiscence and infection, but each case is
particular, so follow the advice of your doctor and nurse. When the wound
is closed, how can you take proper care of the scar?
Remember, the scar continues developing up to a year after surgery, so there are
measures that you can take for a better aesthetic outcome. I generally recommend
silicone, either silicone gels or patches. For me this is basic and in my
opinion the best treatment available. This prevents hypertrophic scars and
improve the final aesthetic appearance. Follow the instructions of the product, ask your doctor or your pharmacist if in doubt
and use the presentation more suitable and comfortable to you. Other well-known measures are keeping
your skin moisturised with a good moisturizer , massaging your skin gently,
and you can also use Rosa Mosqueta oil. The last but not the least is that you
need to protect your scar from ultraviolet radiation. Actually, we all
need to protect our skin from UV rays. How? First, seek shade, sun is
not our enemy but we shouldn’t expose too much to it. Protect your skin with clothing,
protect your eyes with sun glasses and your scalp and face with a hat. Definitely, sunscreen is not enough! Of course you have to use sunscreen. I always recommend sunscreens with at least 50 SPF. Reapply it regularly and generously. Forget about
water resistance, reapply it after swimming. Of course, avoid tanning beds and sun lamps!! These are your skin’s worst enemies!!
Finally, ask your doctor if you need to take a vitamin D supplement, we don’t need
that much UV rays to produce vitamin D in our skin, but it depends
also on your case and maybe your doctor deems necessary checking your vitamin D levels.

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