Mr Cameron being awarded his PhD with his mentors Professor Michael Horowitz and Professor Karen Jones
The Skin, Wound Healing and Scarring.
Last week Mr Cameron was in Adelaide having his PhD in wound healing and scar management conferred. Although this was primarily a lab based research project, Dr Cameron is a wealth of knowledge in clinical wound healing and scar minimisation.
All FRACS recognised Plastic Surgeons have undergone a broad based yet specialised surgical training program. A large component of training is spent on understanding the integumentary system. The integumentary system is the technical term for the covering of the body and includes skin, hair, nails and endocrine components. Studies include understanding the anatomy of the skin, physiology of the skin, and the effects of ligaments, muscles and movement has on the skin as well as aesthetic components of the skin. This therefore provides Plastic Surgeons with the best opportunity of minimising skin hair and nail defects following surgery or trauma.
With all injury to the skin, the body heals itself by laying down more collagen. During our last staff training session, Dr Cameron outlined some of the factors that affect wound healing, collagen deposition and ultimately scar formation.
Attributes intrinsic to the patient include patient’s genetics, patient’s race ( darker skin is more likely to form keloid scar as opposed to Anglo-Celtic skin) and patients age (it is known that no scars are formed in-utero).
A patient’s health is also likely to influence healing. If a patient is of good health, has good nutrition and does not smoke then they are likely to heal quicker and therefore have less scarring than someone who is not. Things like diabetes, corticosteroid use, and vascular disease will all affect the bodies ability to heal. Immunosuppressants and Radiation will also affect wound healing. Being overweight will affect wound healing as fat is poorly vascularised and therefore is more prone to poor healing.
Type of wound:
It is not hard to understand that a meticulously planned and implemented surgical incision following anatomical / aesthetic guidelines is going to heal much better than a wound that involves widespread tissue damage, has significant contamination /dirt or is randomly placed such is the case with trauma or perhaps being performed by less qualified or experienced practitioners/surgeons.
Location of the wound:
Different areas of the body are covered in different types of skin. The skin on your palms and soles are glabrous (without hair) and will heal at a different rate to other parts of the body. Wounds inside the mouth heal up to 10 times faster than other areas of the body. It is also known that when a wound crosses a joint (and has extra tension placed on it), that a thicker scar is likely to develop.
In elective surgeries, meticulous planning is required to ensure that the incision is placed in the optimal position to achieve both clinical, functional and aesthetic goals.
Atraumatic handling of tissues will also result in a reduction in tissue trauma, inflammation and therefore scarring.
A wound needs a clean moist environment to heal. If the wound is desiccated (dried out) the necessary healing mediators are not able to perform their jobs. However if the wound is too wet then healing and healthy tissue can start to breakdown. Your clinician will advise you on the appropriate wound care and dressing to maintain an optimum environment for your wound
What can I do to optimise my wound healing and scarring?
* As mentioned previously, with all surgery there will be a scar. Although scars take more than 12 months to mature, ( if your scar is still red it is still actively maturing) - Over time most scars become flatter and paler. The most important thing is to give your wound time.
* . However, it is important to do as much as you can in the first 12 weeks after surgery to optimise your outcomes. These are some of the ways that can help.
* . Stop Smoking. Ideally you should cease smoking 12 weeks prior to surgery. People who smoke are more likely to suffer infections, heal slower and ultimately have worse scars. This is particularly so if surgery is to the peripheries.(hands, feet, face).
* . Ensure Optimum nutrition, During wound healing the body requires increased protein, adequate calories, increased Vitamin A and C and sometimes the mineral zinc.
* . Follow your clinicians instructions. Many people believe that they are a “good healer” and ignore medical instructions. A predetermined tissue healing pathway means that most scars are only approximately 50% of normal tensile strength by 6 weeks post surgery.
* . Minimise tension / stress on the wound. One of the main features of dressings that are applied post surgery is, as well as providing a suitable wound environment, is that they shield the wound from stress. The more stress we apply to the wound, the more scar tissue the body produces to protect itself. This also means limiting physical activity as instructed by your clinician to prevent unsatisfactory wound healing.
* . Follow the principles of moist wound healing as instructed by your clinician / surgeon. Traditionally patients were told to keep the wounds dry. It is still not uncommon for patients to remove their dressing and dry their wounds out in the sun. We now know that wounds require a moist environment in which to allow the physiological processes required, including cell migration into the wound.
* . When the wound is healed. There are many topical products to help minimise scar healing. Most do not have a great deal scientifically significant evidence. However what is commonly understood is that by reducing moisture loss from the scar we will help prevent the body from producing more scar tissue in an attempt to keep the body “watertight”. Lightly massaging any moisturising emollient product that is non irritating (Sorbolene, Vitamin E Cream etc are fine) helps protect the skin from moisture loss. Many Silicone based products are also available and may help with scar healing. These also act to prevent water loss from from the scar.
* . Seek out appropriately trained professionals to undertake procedures that are required. Having an appropriately trained and experienced surgeon who has a full understanding of tissue healing and the integumentary system will go a long way to optimising wound and scar outcomes from a functional and aesthetic basis.
At Sandhurst Plastic Surgery we are privileged to have Mr Alex Cameron and Mr Broughton Snell who are both FRACS recognised Plastic Surgeons who can offer expert techniques in minimising scarring from a surgical and wound healing perspective. Our surgeons are also supported with advanced skilled nurses and occupational therapists who can provide adjunctive treatment such as compression garments, skin care products, contact media and Dermapen 4