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Opening Up About Wounds: A Review of Better Alternatives


January 23, 2020

Skin Cancer Treatment
We all face some form of injury in our lifetime. From superficial, small cuts and abrasions, to deeper, bigger wounds ¬– knowing how to take care and manage your wound for optimal healing is key to ensuring you live your best life for years to come.

This is referred to as wound care management in the medical field – and is what doctors, nurses and other medical professionals use as part of any treatment.

A common type of wound that we end up managing is the skin defect that results after the surgical treatment of various types of skin cancers. Upon the confirmation of the presence of a skin cancer following skin cancer screening, the doctor will often recommend that the patient undergo surgery to remove the tumor as soon as possible.

Mohs Micrographic Surgery for Skin Cancer


At our clinic, we utilize what is recognized globally by organizations such as the Skin Cancer Foundation, and institutions such as MD Anderson and Mayo clinic. With a solid 95% – 99% cure rate – the Mohs micrographic surgery (MMS) is considered to be the gold-standard for treating skin cancer.

Not only does the procedure allow for the doctor to ensure that all cancerous cells are removed; but it also has a low recurrence rate that works great on sensitive areas such as the eyelids and lips.

During the procedure, the doctor will then have to decide on how to close up the wound – which is highly-dependent on each individual and the wound type.

Primary vs. Secondary Intention Healing


The main objective wound care after surgery is to prevent the wound from being exposed to bacteria and lowering the risks of infection; as well as supporting the healing process.

There are 2 main ways that a doctor can choose to close up the wound, namely: primary intention and secondary intention (SI) healing.

Primary intention occurs where surgical incisions are closed with sutures, surgical glue, staples or stitches; and is currently the most frequently chosen wound healing method. There are various reconstructive options available which range from a simple direct closure to a full thickness skin graft, or a locoregional skin flap.

SI healing on the other hand, are wounds that are left open to heal. It is primarily chosen when the skin edges cannot be closed, or is determined to be at a high risk of infection. In addition, older patients, and those with pre-existing skin damage often face an impaired wound healing process. The same goes for tumors on the scalp and limbs – seeing that they are under constant tension from daily living. In all of these cases, SI healing is the highly-recommended method for better healing.

Compared to primary intention – SI healing offers the advantage of shorter surgical times, a lower risk of affecting surrounding tissues, and facilitates follow-ups of any recurrence.

However, it often requires a longer period of time to completely heal – which is a major concern for both doctors and patients.

Even so, research has shown that in the case of Mohs surgery – SI healing is one of the methods with the highest patient satisfaction post-treatment.1 There has also been a resurgence of the method in recent years, and the call for more studies to be conducted as the advantages of MMS may be optimized in many more areas than traditionally believed. 2

Complementary Antiseptics for SI Healing


Any healing process goes through these 3 main stages:

1) Inflammation
2) Proliferation
3) Maturation

While there is no need to get into details of each stage – it is important to note that the second stage of proliferation is where wounds begin to be rebuilt with new, healthy tissues. Granulation, as doctors like to call it, is a sign to establish that the body is healing properly.

In addition to ensuring that the wound heals nicely, scar prevention is also an important measure of whether the treatment is successful.

Wound dressings are another supplement in wound care management that helps act as a protective barrier to prevent infection, as well as maintain moisture. Not only does it need to be effective in these factors – it also needs to be cost-effective and easy to apply.

Most commonly, you will see doctors using antibiotic ointments such as mupirocin for wounds – but there are now reports suggesting that silicone gels (SG) may be beneficial to help with accelerating the healing process of wounds; encouraging a healthy environment for wounds to heal.

A 2016 Cochrane review showed the lack of evidence to support any single antiseptic agent as an effective treatment complementary for SI wound healing.3

That was until 2018, when Dr Angeline Yong published a pilot case series in which 3 patients received a bacteriostatic SG to treat their wounds by SI, following tumor excision on the scalp and extremities – and concluding with great results.4

More recently, a study utilizing SG to enhance wound healing by SI was presented at the American Academy of Dermatology (AAD) 2019.5 Dr Angeline Yong was the principal investigator of the study, which demonstrated statistically significant reduced times needed for wounds to heal with SG, as compared to the arm utilizing standard-of-care dressings with mupirocin antibiotic ointment. The study’s objective was to address the lack of previous high-quality studies in reviewing dressing and topical agents for SI healing.

In order to gather data, retrospective medical records were reviewed from 31 October 2012 to 30 October 2017 from the National Skin Centre of Singapore.

The results? The support of SG as a post-op dressing for open wounds – seeing that the time taken for full healing being significantly different as compared to standard-of-care topical dressings.

Not only is SG an effective topical agent for various post-procedure indications, including laser treatment, non-healing scalp wounds and scarring caused by third degree burns – patients who aren’t healing well can see quicker improvement after applying SG when indicated.

What the Future Holds


In essence, there is increasing evidence for the increased use of SI healing post-surgery, as well as utilizing SG to accelerate healing in open wounds.

While there is a need for more studies to be conducted – we can be assured that applying evidence-based, wound care management is essential as new and improved techniques and insights are discovered.

At AYD, we pride ourselves in providing progressive and innovative dermatological solutions, including suitable reconstructive options tailored to the individual patient’s needs. Our aim is to optimize the advantages of SI in patients where this may be indicated, and along with improved post-op wound care – minimize healing times.

Putting patients first is always at the forefront at our clinic, regardless of whether you are undergoing an ablative laser treatment for surgical scars, or skin tumor surgery such as Mohs Micrographic Surgery!

Dr Angeline Yong is a dermatologist with over 15 years in medical practice, and a robust background and research in skin cancer management. Contact us to get a complete skin assessment and sound, professional advice today!

References:

1. Yong AA, Tan V, Craythorne E, Mallipeddi R. Piloting a new patient-related outcome tool to assess cosmetic outcome in Mohs Micrographic surgery. J Eur Acad Dermatol Venereol. 2017; 31(10):e455-e457.
2. Vedvyas C, Cummings PL, Geronemus RG, Brauer JA.
Broader Practice Indications for Mohs Surgical Defect Healing by Secondary Intention: A Survey Study. Dermatol Surg 2017; 43(3):415-423.
3. Norman G, Dumville JC, Crosbie EJ. Antiseptics and Antibiotics for Surgical Wounds Healing by Secondary Intention: Summary of a Cochrane Review. JAMA dermatology. 2016 Nov 01;152(11):1266-8. PubMed PMID:27681006.
4. Yong AA, Goh CL. Use of silicone gel to enhance skin wound healing by secondary intention following tumour excision on the scalp and extremities. Clin Exp Dermatol. 2018; 43(6):723-725.
5. Fong K, Yong AA. The use of silicone gel to enhance wound healing by secondary intention following tumour excision on the scalp and extremities – a descriptive study. Presentation at the 77th Annual American Academy of Dermatology 2018.

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