Opening Up About Wounds: A Review of Better Alternatives

January 23, 2020

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.

Use of this website signifies your agreement to The Terms of Use & Privacy Policy

Terms of Use

You are deemed to have entered into an agreement with Angeline Yong Dermatology and to have agreed to be bound by the terms set out below by accessing ayd.com.sg (“the Sites”) or by otherwise accessing any content found on this web site. By accessing or using the Site, you acknowledge that you have read, understood, and agreed, without limitation or qualification, to be bound by these Terms & Conditions. The Site is owned and operated by Angeline Yong Dermatology.

Intellectual Property Protection
Use of Angeline Yong Dermatology Content
Changes to the Site
Privacy Policy
No Warranty, Disclaimer of Liability and Indemnity
Force Majeure
Miscellaneous
Governing Law and Jurisdiction

Intellectual Property Protection

The contents and design of the Site and any material e-mailed to you or otherwise supplied to you in conjunction with the Site (such contents, design and materials being collectively referred to as the “Angeline Yong Dermatology Content”, are copyright of Angeline Yong Dermatology. You may not use or reproduce or allow anyone to use or reproduce any trademarks (such as ” Angeline Yong Dermatology” name and logo or other trade names appearing on the Site) for any reason without written permission from Angeline Yong Dermatology. The software, which operates the Site, is proprietary software and you may not use it except as expressly allowed under these Terms. You may not copy, modify, reverse engineer or otherwise interfere with the software.

Use of Angeline Yong Dermatology Content

You may retrieve and display the Angeline Yong Dermatology Content on a computer screen or mobile telephone, print individual pages on paper (but not photocopy them) and store such pages in electronic form for your personal, non-commercial use. You may not save or post any of the Content on blogs, Facebook, and other websites that allows viewing by the general public without written permission from Angeline Yong Dermatology. Except as expressly set out above, you may not reproduce, modify or in any way commercially exploit any of the Angeline Yong Dermatology Content.

Changes to the Site

Angeline Yong Dermatology reserves the right to change, modify, suspend, add or remove portions of the Angeline Yong Dermatology Content available on the Site at any time and to restrict the use and accessibility of the Site in its discretion and without prior notification.

Privacy Policy

The information that you provide about yourself and your company to Angeline Yong Dermatology will only be used in accordance with Angeline Yong Dermatology’s Privacy Policy Statement. We will:

retain your information only for as long as there is a business need
take reasonable steps to ensure that the information is accurate, adequate, relevant and up to date.
update or correct your information held by us whenever necessary
take appropriate measures to prevent and minimize risks of unauthorised access to the information

We may use your personal information, such as your name and contact details, for the following purposes:

to perform the services that you have requested, which may involve contacting you by telephone, mobile phone, fax machine, post or email, including sending you electronic direct mailers.
to allow us to promote our products, events and activities.

No Warranty, Disclaimer of Liability and Indemnity

Whilst every effort has been made to ensure the high quality and accuracy of the Site, Angeline Yong Dermatology makes no warranty, express or implied, concerning the Angeline Yong Dermatology Content, the Site, software or products or services available through the Site (the “Site Services”), which are provided “as is”. Angeline Yong Dermatology expressly disclaims all warranties, including but not limited to warranties of fitness for a particular purpose and warranties of merchantability. In no event will Angeline Yong Dermatology, its affiliates or other suppliers be liable for direct, special, incidental, or consequential damages (including, without limitation, damages for loss of business profits, business interruption, loss of business information or other pecuniary loss) arising directly or indirectly from the use of (or failure to use) or reliance on the Site Services, even if Angeline Yong Dermatology and its affiliates has been advised of the possibility that such damages may arise.

Angeline Yong Dermatology does not guarantee the accuracy, content, or timeliness of the Site Services or that they or related systems are free from viruses or other contaminating or destructive properties. Angeline Yong Dermatology accepts no responsibility for the content on any site to which a hypertext link from this site exists. The links are provided “as is” with no warranty, express or implied for the information provided within them.

Upon accessing to this Site, you agree to indemnify and hold harmless Angeline Yong Dermatology and its affiliates from any claims and expenses, including reasonable legal fees, related to any breach of these Terms by you or your use of any Site Services.

Force Majeure

Angeline Yong Dermatology and its affiliates will not be liable or deemed to be in default for any delay or failure in performance or interruption of the delivery of the Angeline Yong Dermatology Content resulting directly or indirectly from any cause or circumstance beyond its or their reasonable control, including but not limited to failure of electronic or mechanical equipment or communication lines, telephone or other interconnect problems, computer viruses, unauthorized access, theft, operator errors, severe weather, earthquakes or natural disasters, strikes or other labour problems, wars, or government restrictions.

Miscellaneous

Changes to these Terms. Angeline Yong Dermatology may, in its discretion, change these Terms (including those relating to your use of Site and/or the Angeline Yong Dermatology Content. When Terms are changed, Angeline Yong Dermatology will notify you by email or by publishing details of those changes by including them in these Terms. If you use the Site after Angeline Yong Dermatology has published or notified you of the changes, you are agreeing now to be bound by those changes. If you do not agree to be bound by those changes, you should not use the Site any further after they are published. Access to certain areas of the Angeline Yong Dermatology Content may be subject to additional terms and conditions.

Advertising, Third Party Content and other Web Sites. Parts of the Site may contain advertising or other third-party content. Advertisers and other content providers are responsible for ensuring that material submitted for inclusion on the Site complies with international and national law. Angeline Yong Dermatology is not responsible for any third-party content or error, omission or inaccuracy in any advertising material. The Site may contain links to other web sites. Angeline Yong Dermatology is not responsible for the availability of these web sites or their contents.

Assignment of Agreement. This agreement is personal to you and your rights and obligations under these Terms may not be assigned, sub-licensed or otherwise transferred. This agreement may be assigned to a third party by Angeline Yong Dermatology and its affiliates.

Non-Waiver. No delay or omission on the part of either party in requiring performance by the other party of its obligations will operate as a waiver of any right.

Notices. Notices to Angeline Yong Dermatology and its affiliates must be given in writing by letter.

Severability/Survival/Statute of Limitations. If any provision of these Terms is invalid or unenforceable, such will not render all the Terms unenforceable or invalid but rather the Terms will be read and construed as if the invalid or unenforceable provision(s) are not contained therein. Any cause of action of yours with respect to these Terms must be filed in a court of competent jurisdiction in Singapore, within one year after the cause of action has arisen, or such cause will be barred, invalid, and void.

Whole Agreement. Save as expressly referred to herein, any representation, warranty, term or condition not expressly set out in these Terms shall not apply.

Headings. Headings in these Terms are for convenience only and have no legal meaning or effect.

Governing Law and Jurisdiction

These Terms shall be governed by, and construed in accordance with the Laws of the Republic of Singapore. The parties irrevocably agree that the courts of Singapore shall (subject to the paragraph below) have exclusive jurisdiction to settle any dispute which may arise out of, under, or in connection with these Terms or the legal relationship established by them, and for those purposes irrevocably submit all disputes to the jurisdiction of Singapore courts. For the exclusive benefit of Angeline Yong Dermatology and its affiliates, Angeline Yong Dermatology and its affiliates shall retain the right to bring proceedings as to the substance of the matter in the courts of the country of your residence or, where these Terms are entered into in the course of your trade or profession, the country of your principal place of business.

Media.

Opening Up About Wounds: A Review of Better Alternatives

Mohs Micrographic Surgery for Skin Cancer

Primary vs. Secondary Intention Healing

Complementary Antiseptics for SI Healing

What the Future Holds