title: Can Medical Hypnosis Accelerate Post-Surgical Wound Healing? Results of a Clinical Trial Effect of pantothenic acid and ascorbic acid supplementation on human skin wound healing process. A double-blind, prospective and randomized trial. Enhanced wound healing after emotional disclosure intervention. Stress, Social Support, and Delayed Skin Barrier Recovery Improving Scar Quality: A Prospective Clinical Study Preoperative anxiety in ambulatory surgery: The impact of an empathic patient-centered approach on psychological and clinical outcomes. Mild perioperative hypothermia and the risk of wound infection. A brief relaxation intervention reduces stress and improves surgical wound healing response: A randomised trial A prospective study in children: Pre- and post-surgery use of vitamin E in surgical incisions. Effects of preoperative warming on the incidence of wound infection after clean surgery: a randomised controlled trial Impact of Preoperative Local Water-Filtered Infrared A Irradiation on Postoperative Wound Healing: A Randomized Patient- and Observer-Blinded Controlled Clinical Trial Expressive Writing and Wound Healing in Older Adults: A Randomized Controlled Trial Influence of yoga on postoperative outcomes and wound healing in early operable breast cancer patients undergoing surgery A comparison of two skin preps used in cardiac surgical procedures. Impact of preoperative anxiolytic on surgical site infection in patients undergoing abdominal hysterectomy.
abstract: Abstract Although medical hypnosis has a long history of myriad functional applications ( pain reduction , procedural preparation etc . ) , it has been little tested for site-specific effects on physical healing per se . In this r and omized controlled trial , we compared the relative efficacy of an adjunctive hypnotic intervention , supportive attention , and usual care only on early post-surgical wound healing . Eighteen healthy women presenting consecutively for medically recommended reduction mammaplasty at an ambulatory surgery practice underwent the same surgical protocol and postoperative care  following preoperative r and omization ( n = 6 each ) to one of the three treatment conditions : usual care , 8 adjunctive supportive attention sessions , or 8 adjunctive hypnosis sessions targeting accelerated wound healing . The primary outcome data of interest were objective , observational measures of incision healing made at 1,7 weeks postoperatively by medical staff blind to the participants ' group assignments . Data included clinical exams and digitized photographs that were scored using a wound assessment inventory ( WAI ) . Secondary outcome measures included the participants ' subjectively rated pain , perceived incision healing ( VAS Scales ) , and baseline and post-surgical functional health status ( SF-36 ) . Analysis of variance showed the hypnosis group 's objective ly observed wound healing to be significantly greater than the other two groups ' , p < .001 , through 7 postoperative weeks ; st and ard care controls showed the smallest degree of healing . In addition , at both the 1 and 7 week post-surgical observation intervals , one-way analyses showed the hypnosis group to be significantly more healed than the usual care controls , p < 0 . 02 . The mean scores of the subjective assessment s of postoperative pain , incision healing and functional recovery trended similarly . Results of this preliminary trial indicate that use of a targeted hypnotic intervention can accelerate postoperative wound healing and suggest that further tests of using hypnosis to augment physical healing are warranted This study aim ed at testing human skin wound healing improvement by a 21-day supplementation of 1.0 g ascorbic acid ( AA ) and 0.2 g pantothenic acid ( PA ) .  49 patients undergoing surgery for tattoos , by the successive resections procedure , entered a double-blind , prospect i ve and r and omized study . Tests performed on both skin and scars determined : hydroxyproline concentrations , number of fibroblasts , trace element contents and mechanical properties . In the 18 supplemented patients , it was shown that in skin ( day 8) Fe increased ( p < 0.05 ) and Mn decreased ( p < 0.05 ) ; in scars ( day 21 ) , Cu ( p = 0.07 ) and Mn ( p < 0.01 ) decreased , and Mg ( p < 0.05 ) increased ; the mechanical properties of scars in group A were significantly correlated to their contents in Fe , Cu and Zn , whereas no correlation was shown in group B. In blood ,  AA increased after surgery with supplementation , whereas it decreased in controls . Although no major improvement of the would healing process could be documented in this study , our results suggest that the benefit of AA and PA supplementation could be due to the variations of the trace elements , as they are correlated to mechanical properties of the scars OBJECTIVES Psychological stress is believed to impair wound healing via a down-regulation of the immune system . Since previous research suggests that disclosure of tra-umatic experiences can result in an up-regulation of immune function , the present study aim ed to investigate the impact of a disclosure intervention on the progress of wound healing . DESIGN The study used a prospect i ve , longitudinal design with r and om assignment to the control ( writing about time management ) and experimental group ( writing about a traumatic event ) . METHODS Participants ( N=36 ) completed question naires measuring perceived and emotional distress , loneliness , self-esteem , social support , dispositional optimism , and health-related behaviours . Accurate indication of the healing of a small punch biopsy wound was determined by using a high-resolution ultrasound scanner . RESULTS Repeated measures ANOVA indicated that the disclosure intervention impacted wound healing . Participants who wrote about traumatic events had significantly smaller wounds 14 and 21 days after the biopsy compared with those who wrote about time management . CONCLUSIONS It is concluded that a relatively brief and easy to administer intervention can have beneficial effects on wound healing . The potential for use in patient sample s is indicated Objective : To examine the effect of a brief laboratory stressor and social support before the stressor on cardiovascular and cortisol responses , and skin barrier recovery after skin disruption . Methods : Eighty-five healthy participants ( mean age 22.9 ± 4.4 years ) underwent a “ tape-stripping ” procedure that disrupts normal skin barrier function , and were r and omly assigned to a No Stress ( reading task ) , Stress ( Trier Social Stress Test ) , or Stress + Social Support condition ( support from a confederate before the stressor )  . Skin barrier recovery was assessed by measuring transepidermal water loss from up to 2 hours after skin disruption . Results : Compared with the No Stress condition , the stressor delayed skin barrier recovery by 10 % at 2 hours after skin disruption ( effect size , r = .29 ) , and increased anxiety ( r = .24 ) , negative affect ( r = .22 ) , cardiovascular activity ( r values from .4–.6 ) , and among male participants , cortisol levels ( r = .40 ) . Social support did not influence psychological or physiological responses or skin barrier recovery . Larger physiological responses to the tasks did not predict slower skin barrier recovery . Instead , larger systolic blood pressure responses predicted faster skin barrier recovery ( r = .26 ) . Conclusions : This study replicated the effects of short-term laboratory stressors on skin barrier recovery , further establishing the relevance of skin barrier recovery for future research . The support manipulation did not influence physiological responses or skin barrier recovery , suggesting that future research on social support , physiology , and objective health outcomes should focus on naturalistic social interactions , relationships , and stressors . AUCI = area under the curve with respect to increase ; BMI = body mass index ; DBP = diastolic blood pressure ; GCRC = General Clinical Research Center ; HR = heart rate ; MAP = mean arterial pressure ; SBP = systolic blood pressure ; TSST = Trier Social Stress Test ; TEWL = transepidermal water loss Following traumatic or surgical injury to the skin , wounds do not heal by tissue regeneration but rather by scar formation . Though healing is definitely a welcomed event , the result ant scar , very often , is not aesthetically pleasing , and not infrequently , may be pathologic causing serious deformities and contractures . Management of problematic scars continues to be a frustrating endeavor with less than optimal results . Prophylactic methods of wound management to minimize serious scarring are being developed . In a previously published study , we have demonstrated improved healing of split thickness skin graft donor sites following treatment with Moist Exposed Burn Ointment ( MEBO , Julphar Gulf Pharmaceutical Industries , Ras Al-Kh aim ah , UAE ) . At present , we are reporting the results of a comparative clinical prospect i ve study evaluating scar quality following primary healing of elective surgical and traumatic facial wounds with prophylactic MEBO application , topical antibiotic ointment application , and no topical therapy at all . Scars were evaluated according to the Visual Analogue Scale for scar assessment . Statistical analysis of scar assessment scores demonstrated marked prevention of unfavorable scars with improved cosmetic results following MEBO prophylactic therapy OBJECTIVE This study aims to evaluate the influence of an empathic patient-centered approach on preoperative anxiety and surgical outcomes in ambulatory surgery patients . METHODS A sample of 104 patients undergoing general ambulatory surgery was r and omly assigned to the intervention ( IG ) and the control ( CG ) groups . Before surgery , the IG received personalized information through an empathic patient-centered interview . The CG received st and ardized information on surgical procedures .  Anxiety was assessed before and after the preoperative interview and after the surgery . Wound healing , post-surgical recovery and satisfaction with the quality of preoperative information were assessed after the surgery . RESULTS The two groups were identical at baseline regarding anxiety , socio-demographic and clinical characteristics . After the patient-centered intervention , the IG showed lower levels of preoperative anxiety ( p<0.001 ) and pain ( p<0.001 ) , better surgery recovery ( p<0.01 ) and higher levels of daily activity ( p<0.001 ) and of satisfaction with the information received ( p<0.01 ) than the CG . The IG also showed better wound healing ( tissue type , p<0.01 ; local pain , p<0.01 ) . CONCLUSION An empathic patient-centered intervention can reduce preoperative anxiety and increase surgical recovery , wound healing and patient satisfaction . PRACTICE IMPLICATION S This approach is applicable in pre-surgical interviews and can potentially be used in the routine care of various surgical context BACKGROUND Bacterial destruction caused by free radicals , which are synthesized by neutrophils in the presence of oxygen , depends on adequate tissue perfusion . Mild perioperative hypothermia causes vasoconstriction , reducing nutrient and oxygen supply to wounds and increasing frequency of surgical wound infection . However , the causal role of hypothermia in surgical wound infection is the subject of controversy . The present work proposes the hypothesis that mild perioperative hypothermia is associated with infection of the surgical wound . METHODS A prospect i ve cohort of 290 surgical patients was studied in a second-level hospital ; 261 ( 90 % ) of the patients concluded the follow-up . The relationship of hypothermia and of other confounding factors , such as diabetes mellitus , antibiotic treatment , and wound drains with infection outcome was evaluated . One physician , blinded to patient hypothermia , gathered the data . Surgical wound infection was defined as the surgeon 's diagnosis with positive culture . RESULTS Twenty subjects ( 7.6 % ) showed infection of surgical wound ; 18 ( 11.5 % ) of 156 hypothermics and two ( 2 % ) 105 normothermics ( p = 0.004 ) . Hypothermia proved to be a significant independent risk of infection with relative risk of 6.3 ( p = 0.01 ) . CONCLUSIONS Mild perioperative hypothermia is associated with infection of the surgical wound and its prevention is therefore justified Psychological stress has been shown to impair wound healing , but experimental research in surgical patients is lacking . This study investigated whether a brief psychological intervention could reduce stress and improve wound healing in surgical patients . This r and omised controlled trial was conducted at a surgical centre . Inclusion criteria were English-speaking patients over 18 years booked to undergo elective laparoscopic cholecystectomy ; exclusion criteria were cancellation of surgery , medical complications , and refusal of consent . Seventy five patients were r and omised and 15 patients were excluded ; 60 patients completed the study ( 15 male , 45 female ) . Participants were r and omised to receive st and ard care or st and ard care plus a 45-min psychological intervention that included relaxation and guided imagery with take-home relaxation CDs for listening to for 3 days before and 7 days after surgery . In both groups ePTFE tubes were inserted during surgery and removed at 7 days after surgery and analysed for hydroxyproline as a measure of collagen deposition and wound healing . Change in perceived stress from before surgery to 7-day follow-up was assessed using question naires . Intervention group patients showed a reduction in perceived stress compared with the control group , controlling for age . Patients in the intervention group had higher hydroxyproline deposition in the wound than did control group patients ( difference in means 0.35 , 95 % CI 0.66 - 0.03 ; t(43)=2.23 , p=0.03 ) . Changes in perceived stress were not associated with hydroxyproline deposition . A brief relaxation intervention prior to surgery can reduce stress and improve the wound healing response in surgical patients . The intervention may have particular clinical application for those at risk of poor healing following surgery BACKGROUND One of the main problems of elective surgery is the cosmetic result . OBJECTIVE This prospect i ve controlled study aims to determine the effects of topical vitamin E on cosmetic results in children . METHODS A single-blind study was carried out . Topical vitamin E was used on the intended incision site for at least 15 days , thrice daily , before surgery and for at least 30 days , twice daily , after surgery ( group A ) . The control group received topical petrolatum-based ointment ( group B ) . RESULTS No patients in group A developed keloids . A total of 96 % of patients ( or parents ) considered the cosmetic results very good . No patients had wound infection . In the control group , only 78 % of patients ( or parents ) considered the cosmetic results very good and 13 ( 6.5 % ) patients developed keloids after 6 months . There were no cases of wound infection . CONCLUSION Topical vitamin E before and after surgery improved surgical wound healing and improved cosmetic results BACKGROUND Wound infection after clean surgery is an expensive and often underestimated cause of patient morbidity , and the benefits of using prophylactic antibiotics have not been proven . Warming patients during colorectal surgery has been shown to reduce infection rates . We aim ed to assess whether warming patients before short duration , clean surgery would have the same effect . METHODS 421 patients having clean ( breast , varicose vein , or hernia ) surgery were r and omly assigned to either a non-warmed ( st and ard ) group or one of two warmed groups ( local and systemic ) . We applied warming for at least 30 min before surgery . Patients were followed up and masked outcome assessment s made at 2 and 6 weeks . FINDINGS Analysis was done on an intention-to-treat basis . We identified 19 wound infections in 139 non-warmed patients ( 14 % ) but only 13 in 277 who received warming ( 5 % ; p=0.001 ) . Wound scores were also significantly lower ( p=0.007 ) in warmed patients . There was no significant difference in the development of haematomas or seromas after surgery but the non-warmed group were prescribed significantly more postoperative antibiotics ( p=0.002 ) . INTERPRETATION Warming patients before clean surgery seems to aid the prevention of postoperative wound infection . If applied according to the manufacturers guidelines these therapies have no known side-effects and might , with the support of further studies , provide an alternative to prophylactic antibiotics in this type of surgery Objective : In addition to a preoperative antibiotic single-shot prophylaxis , we tested the impact of a one-time preoperative water-filtered infrared A irradiation ( wIRA ) on postoperative wound healing of patients . Background : wIRA improves wound healing in postoperative setting s. Methods : A total of 400 consecutive patients undergoing gastrointestinal surgery were r and omly assigned to the treatment group ( A ) or placebo group ( B ) . We applied wIRA for 20 minutes while patients were prepared for surgery . Patients and observer were blinded to group assignment . Primary endpoints were surgical site infections ( SSIs ) , wound healing , and rate and level of pain within 30 days after surgery . Primary efficacy analysis was carried out on the basis of an intention-to-treat ( ITT ) population and a full- analysis set ( FAS ) . Missing values of primary outcome variables were considered as SSIs and maximum pain levels in the ITT analysis , respectively . Results : FAS : The incidence of SSI was 9 of 178 patients ( 5.1 % ) within group A compared with 22 of 182 ( 12.1 % ) within group B [ P = 0.018 ; relative risk ( RR ) = 0.42 ; 95 % CI : 0.18–0.93 ] . ITT : 32 of 200 ( 16 % ) SSIs occurred within group A and 39 of 200 ( 20 % ) within group B ( P = 0.248 ) with an RR of 0.74 ( 95 % CI : 0.43–1.28 ) . The wIRA group showed lower postoperative pain at both the ITT ( P = 0.092 ) and the FAS analysis ( P = 0.045 ) . Conclusions : This trial indicates a clinical ly relevant benefit of one-time application of preoperative wIRA as a supportive addition to prophylactic antibiotics . wIRA contributes to both reduced SSI rates and postoperative pain but also effectively decreases morbidity and related expenses in the health care system Objective To investigate whether expressive writing could speed wound reepithelialization in healthy , older adults . Methods In this r and omized controlled trial , 49 healthy older adults aged 64 to 97 years were assigned to write for 20 minutes a day either about up setting life events ( Expressive Writing ) or about daily activities ( Time Management ) for 3 consecutive days . Two weeks postwriting , 4-mm punch biopsy wounds were created on the inner , upper arm . Wounds were photographed routinely for 21 days to monitor wound reepithelialization . Perceived stress , depressive symptoms , health-related behaviors , number of doctor visits , and lipopolysaccharide-stimulated proinflammatory cytokine production were also measured throughout the study . Results Participants in the Expressive Writing group had a greater proportion of fully reepithelialized wounds at Day 11 postbiopsy compared with the Time Management group , with 76.2 % versus 42.1 % healed , & khgr;2(1 , n = 40 ) = 4.83 , p = .028 . Ordinal logistic regression showed more sleep in the week before wounding also predicted faster healing wounds . There were no significant group differences in changes to perceived stress , depressive symptoms , health-related behaviors , lipopolysaccharide-induced proinflammatory cytokine production , or number of doctor visits over the study period . Conclusions This study extends previous research by showing that expressive writing can improve wound healing in older adults and women . Future research is needed to better underst and the underlying cognitive , psychosocial , and biological mechanisms contributing to improved wound healing from these simple , yet effective , writing exercises . Trial Registration : Australian New Zeal and Clinical Trials Registry ( trial number 343095 Context : Pre- and postoperative distress in breast cancer patients can cause complications and delay recovery from surgery . Objective : The aim of our study was to evaluate the effects of yoga intervention on postoperative outcomes and wound healing in early operable breast cancer patients undergoing surgery . Methods : Ninety-eight recently diagnosed stage II and III breast cancer patients were recruited in a r and omized controlled trial comparing the effects of a yoga program with supportive therapy and exercise rehabilitation on postoperative outcomes and wound healing following surgery . Subjects were assessed at the baseline prior to surgery and four weeks later . Sociodemographic , clinical and investigative notes were ascertained in the beginning of the study . Blood sample s were collected for estimation of plasma cytokines — soluble Interleukin (IL)-2 receptor ( IL-2R ) , tumor necrosis factor (TNF)-alpha and interferon (IFN)-gamma . Postoperative outcomes such as the duration of hospital stay and drain retention , time of suture removal and postoperative complications were ascertained . We used independent sample s t test and nonparametric Mann Whitney U tests to compare groups for postoperative outcomes and plasma cytokines . Regression analysis was done to determine predictors for postoperative outcomes . Results : Sixty-nine patients contributed data to the current analysis ( yoga : n = 33 , control : n = 36 ) . The results suggest a significant decrease in the duration of hospital stay ( P = 0.003 ) , days of drain retention ( P = 0.001 ) and days for suture removal ( P = 0.03 ) in the yoga group as compared to the controls . There was also a significant decrease in plasma TNF alpha levels following surgery in the yoga group ( P < 0.001 ) , as compared to the controls . Regression analysis on postoperative outcomes showed that the yoga intervention affected the duration of drain retention and hospital stay as well as TNF alpha levels . Conclusion : The results suggest possible benefits of yoga in reducing postoperative complications in breast cancer patients Postoperative surgical site infections contribute significantly to increased patient morbidity and mortality rates and unnecessary hospital costs . Effective and efficient preoperative patient skin preparation is an important perioperative nursing intervention that decreases the number of wound contaminants and reduces the risks for postoperative surgical site infections . This study examined the effectiveness and time and material costs of two preoperative patient skin prep methods ( ie ,  isopropyl alcohol prep/iodophor-impregnated adhesive drape method , iodophor scrub and paint prep/plain adhesive drape method )  . The isopropyl alcohol prep/iodophor-impregnated adhesive drape method clinical ly was as effective as the iodophor scrub and paint prep/plain adhesive drape method , more cost-effective when time and material s were compared , and less cost-effective when material s alone were compared . To make appropriate decisions about the use of preoperative patient skin prep methods , perioperative nurse managers and staff members need to examine and determine whether costs in time or material s have the greater impact on their surgical setting BACKGROUND An increased anxiety may be associated with a higher risk of surgical site infection ( SSI ) , but there is little objective data on the effect of preoperative anxiolytic interventions on SSI . To address this issue , we evaluated the effects of preoperative diazepam on postoperative SSI  following abdominal hysterectomy . METHODS This r and omized , double-blinded , placebo-controlled study included 130 patients , American Society of Anesthesiologist physical status 1 or 2 . Patients were r and omly assigned to receive either oral diazepam 10 mg ( n = 65 ) or placebo ( n = 65 ) the night before and 1 hour prior to surgery . The assessment instruments were the Visual Analogue Scale and the State-Trait Anxiety Inventory . SSI was diagnosed according to the criteria of the Centers for Disease Control and Prevention with st and ard follow-up of 30 days . RESULTS The relative risk ( RR ) was 1.79 ( 95 % confidence interval [ CI ] : 1.31 - 2.43 ) , and the number of patients that needed to be treated was 5.2 ( 95 % CI : 2.74 - 50.76 ) to prevent 1 additional SSI . The RR for SSI in placebo-treated patients with high postoperative anxiety was 1.65 ( 95 % CI : 1.07 - 2.56 ) . CONCLUSION Diazepam-treated patients showed lower postoperative anxiety and lower incidence of SSI up to 30 days after surgery compared with placebo in patients undergoing abdominal hysterectomy
target: Conclusions This systemic review shows that preoperative interventions can be beneficial in improving wound healing and scar formation .
  In selected cases , wound healing was found to benefit from a higher preoperative body temperature , topical vitamin E application , and low patient stress levels .
background: Background Poor wound healing and scar formation  remain critical problems in daily surgical practice .
  Generally , most attention is paid to intra- and postoperative interventions to improve wound healing after surgery , while preoperative interventions remain unsatisfactorily explored .
  Objectives In this systematic review , the available literature on the beneficial effects of preoperative interventions on wound healing and scar formation have been summarized and compared .