Since 90% of wound healing is done at home, it is important for patients to educate themselves about proper wound care to optimize healing following treatment. Dr. Maas gives his guide for best practices for wound care.
“I’m here with my fellow today Dr. Dan Bats and we’re going to talk a little bit about wound care. I think there’s not enough emphasis on what when we take care of wounds all the time and we certainly know a lot about it and enjoy it but when a patient comes and has surgery unless they’ve had a little bit of education and knowledge about how to take care of their wounds at home then we can really get behind the 8 ball and in fact 90% of the wound care done after Facelift, Eye Lid Surgery you’re surgery brow plasty, any of the surgeries with you frankly the nose surgery, 90% of the wound care’s done by the patient at home. So having a good perspective on what to do and the things that you can do to make sure you’re improving your outcome by doing the best wound care is really what we’re talking about today and I’d break that down into really couple’s simple systems in a couple of simple principles.
The first one is, that wounds heal best in a moist clean environment. So when we talk about moist now a lot of people think that a hard scab for example is the waste scab or wound should heal and that’s good. Scabs are never good for wound healing because mechanically if the skin heals the bridge, even if we’ve connected them together with sutures there’s a small bridge effect or little gap microscopic and in the case of sutures where the skin cells have to migrate across, it’s a physical activity that takes mechanical energy from the body to occur.
When there’s a scab in between those edges it literally has to push that hard plug out of the way to get those skin edges to meet. So as I tell all of our patients the ideal wound, scab if you will is a soft gooey scab, a lot of people ask about this with not much surface area usually that we see with this except in skin resurfacing but soften gooey or a nice clean edge with ointment on it more importantly when there’s sutures involve is ideally what we see. So when we’re taking care of wounds at home I think its also important to understand that probably the best thing we can use is keep things clean, soap and water maybe the best anti-microbial there is. So in our typical skin care regimen or asking people to two times today wherever there’s incisions or wounds that we’ve made sutures are no sutures either one that they’re washing with soap and water and that they’re applying an ointment. Now, sometimes when I say an ointment I typically recommend an anti-biotic ointment, there’s many, many out there we use triple anti-biotic ointment like this I’m not brand specific we’ll often use bacitracin and really brands don’t matter very much they all made a good standard for activity and they really serve if you think of a nice layer of ointment over a wound as a physical barrier or Band-Aid so really using these when we have incisions around and behind the ears facelift right in the collumela or just on the inside of the nose on Rhinoplasty and the upper lids with Blepharoplasty. Often I’ll choose something that doesn’t have any microbial like an aquaporin product or special product that I have formulated has some growth factors and other things in it but basically these don’t have things that are eye irritants. The problem with the ones that have antibiotic on them is they can kind of melt and run in the eye. So that’s the one exception but in general moisture with some type of an ointment is really important in terms of promoting wound healing and then when people ask me “Will washing with soap and water when can you do that?” Well every doctors kind of have some different idea about that, we typically will start the second day after surgery with soap and water washes, a good anti-bacterial soap like dial. If you want to get fancy and new something like hibiclens or one of the other sort of more sophisticated anti-microbial it’s fine but really any anti-microbial and you know dial soap is probably the most commonly known one, or fine. In fact, I tell patients really to get liquid dial soap put it in the shower with them and when they have incisions behind their ears like they would in the face lift just what use it like shampoo we’re not worried so much about the hair do at that point and we really want things clean, we don’t want to soap saturated or have it on there for a long time and in fact we don’t want to shower, we don’t even want to bath, we want to be in the shower lather up, let the soap clean everything off, rinse it carefully path it dry and that’s really dependent upon the type of surgery you do with for example, Rhinoplasty surgery or no surgery wouldn’t want to get the cast wet and there’s some alternatives we can use in those cases to the uses of soap and most important one probably is hydrogen peroxide. I think hydrogen peroxide is one of misunderstanding about it, there’s 2% you get this with any pharmacy we give it to our patients anyway and it’s applied with cue tips but hydrogen peroxide on open wounds like a sort that you might get if you skinned your knee is not good, it actually in peace wound healing but when they’re close and their sutures there it’s very effective in debriding it sort off bubbles when you apply it and that sort of taking up the little dry blood or scabs and helping them come to this surface and then they can be gently patted away and one of the ointments then applied that we talked about.
So this is true in general and what we’ll do is take a clean little cup we don’t dip this back in on to our face and then went to the bottle back onto their face that’s contamination but we’ll have a little intermediate sort of medicine cup type of thing in our clinic we keep this around but at home you can just use something clean and I think the most important part of this is making sure that you’re using clean hands, that probably is the second most important message that I’d give you anyone doing wound care is that if you’re hands aren’t washed frequently we inadvertently touch things all day, many people have pets and you know other types of things that they’re going to touch which are potentially contaminated and so washing their hands frequently will keep us from touching something not good and then touching your face. Dogs maybe clean, cats maybe clean, cats saliva has a lot of bacteria, dogs saliva obviously we didn’t know what dogs lick and eat so we just really want to wash our hands put pets in particular in general but just in the environment wherein we’re touching things that may or may not be contaminated.
So when we’re cleaning wounds with peroxide like we might in Rhinoplasty just a little drop on the cue tip and now insert it into the fetivile just to where the cotton ends really and just gently let that bubble when clean any crusting or debris around the inside of the nose.
Noses are little unique we use lots of saline washes instead of soap and water to clean the nose and flash that out but in principle we’re able to clean the dissolvable sutures inside the nose with little peroxide and then apply a little bit of antibiotic ointment again just to the end of the cue tip on the inside of the nose if we’re doing it and cue tips are nice to have they don’t have to be sterile like this as long as they’re clean out the package and people have clean hands, at home we’re not in the sterile environment anyway.
But the other way to do it is make sure and wash your hands generous applications of the ointment along any suture line or any open wound as we describe is very, very important.
So to summarize this wound care is a very important part of what you, the patient can do to make sure that your healing is fast, effective and germ-free, we don’t want any infections in our patients and that’s the main thing to avoid. Hand washing is critical and then doing washing and keeping them wound moist, wounds heal best in a moist clean environment. So there’s lots of ways in keeping moisture on their follow the recommendation of your doctor. We have a series of antibiotic ointments that we give our patients is part of their Post-Operative package and any of the soap that anti-microbial are completely acceptable. In fact any soap at all as you can even use dove soap something gentle mild soap if you so desire.
Dr. Maas: So did I cover everything?
Dr. Bats: I think so. Yeah, absolutely!