The latest November 2018 Aesthetic Surgery Journal had an article about “The Influence of Preoperative interventions on Postoperative Surgical Wound Healing in Patients Without Risk Factors: A Systematic Review.” When you do this kind of study, it is a collation of prior studies done. I think it is a good thing to look at. There was a study a little while back which showed protein loading caused statistically significantly better healing in tummy tuck patients- better scars and lower infections. If doing something simple like eating a few steaks can help you heal, what other tidbits are there out there?
They found 13 studies, all which were randomized trials. (This means they were good science with randomized patients and controls.) Eight of these studies showed significantly better wound healing after a preoperative intervention. They looked at these in three basic categories: SYSTEMIC interventions, TOPICAL applications, and PSYCHOLOGICAL interventions.
So what did they find?
SYSTEMIC TREATMENTS:
- Vitamin Supplements:
- Study on tattoo removal, looked at Vitamin C or Vitamin B5 in the healing. They looked at the quality of the wound healing by looking at hypertrophy, rigidity, collared, elastic stiffness, and stress. Follow up was 80 days. They started the vitamins one week prior to the procedure. FINDING: NO benefit was found.
- Lowering Anxiety:
- They gave Valium 10mg pre surgery to reduce anxiety levels. This was given the night before and the hour before surgery. Pre and Post op anxiety levels were measured. They also measured surgical site infections. FINDING: anxiety and surgical site infections were significantly reduced.
- Increasing body temperature:
- They used a water filtered infrared radiation to warm the patients before surgery, thinking this would help increase artery oxygen levels and reduce surgical wound infections. They looked at postop wound infection, wound healing, and postop pain. They used a visual scale to assess the degree of healing. They looked at things like serous exudate, redness, pus draining and wound cracks. FINDINGS: actively warming the patients preoperatively benefitted wound healing.
- Another study used forced air warming blankets and radiant heat dressings. 416 patients were in this study. One group had standard care, another war warmed a minimum of 30 minutes before the surgery, the third had standard care with local warming by a noncontact radiant heat dressing applied to the planned wound area 30 minutes before surgery. FINDINGS: the two groups warmed before surgery had statistically significantly better wound healing. The nonwarmed group needed significantly more antibiotics postoperatively.
TOPICAL
- Vitamin Supplements:
- Used topical Vitamin E to reduce inflammation and fibroblast proliferation. 428 children having inguinal surgery were studied. Topical Vitamin # was applied twice daily for 2 weeks prior to surgery and twice a day for 30 days after. The other was the control. They were assessed on wound healing and their scar. FINDINGS: 6 month follow up, showed those with topical Vitamin E had significantly better wound healing and better cosmetic results.
PSYCHOLOGIC INTERVENTION
All of these were aimed at lowering stress levels. Why would this matter? People think psychological stress can affect wound healing by triggering inflammation.
- Social support:
- These were looking at cortisol responses and skin recovery after disruption. Three groups: first had a no stress reading task. The second had a social stress test. The third had the stress test and support from a team member. The intervention took pace one hour prior to the skin disruption. FINDING: No difference between the groups.
- Expressive writing:
- Disclosing traumatic experiences can result in lower stress levels and influence the immune system. They were asked to write a bout a traumatic experience preoperatively for 20 minutes. Then a punch biopsy was done. Wounds were evaluated for 3 weeks. FINDINGS: no difference in healing.
- Relaxation Exercises:
- Met with a healthy psychologist for 45 minutes who did deep breathing techniques. They listened to a CD with recordings to listen to daily, starting 3 days prior to lap choly surgery. FINDING: No difference in perceived stress and stress levels following deep breathing exercises.
- Another group tried to increase relaxation by hypnosis prior to surgery in patients scheduled for breast reduction. Three groups were made. First had intervention for 8 half hour weekly sessions starting 2 weeks prior to surgery and for 6 weeks after. The second got supportive attention around the operating at the same time points. The third was the control. FIDINGS: After 7 weeks the hypnosis group was significantly lower on the wound assessment rating, giving the best healing over time, followed by the support group.
- Yoga group done on postoperative healing in breast cancer patients. FINDING: The yoga group scored significantly better than the control for drain removal and suture removal.
- Empathy Patient Centered Info
- One month prior they got personalized info about the operation through an empathic patient centered interview, which explored patient concerns about the surgery for 15 minutes. The control group was told about the surgery. Surgical wound healing and anxiety were then assessed. FINDINGS: One month later it showed significantly better wound healing and lower levels of anxiety.
So what do I think?
All of these are good things to think about. It is hard to assess healing in surgery when there are so many factors affecting it. These studies show that lowering stress, talking about the surgery, keeping warm, and doing scar care are beneficial. This makes sense. I remember a long time ago reading a study which showed patient anxiety and postoperative medication use were significantly reduced if you didn’t gloss over surgery, Instead of candy coating everything, “It’s all going to be fine….” , one should tell patients the truth of what to expect. So I have always met with my patients one on one, and I discuss the reality in blunt terms of what to expect.
This article did not include the protein study I cited above.
I do not advocate Vitamin E (a study comparing it to mederma and kelocote shows kelocote is the best for scarring). I do not advocate yoga for post op patients (I fear they can tear something or cause swelling and bruising, particularly if they are bending over.) I do not give Valium to patients the night prior, as then patients can come in completely out of it and we cannot have a real discussion about their surgery (particularly important to do a final confirmation our surgical plan, size of implants, etc.). My patients do get a relaxant about 20 minutes prior to surgery.
But I will keep reading. I find many pearls on wisdom in my journals.