Postoperative pain relief. Part 4. Modern means of providing postoperative analgesia

From this article you will learn:

• the best ointment for scars and scars on the face and body,
• products with proven effectiveness,
• laser scar removal – prices, before and after photos,
• scar after cesarean section - photo, how to treat.

A scar is an area of ​​fibrous tissue that forms on the skin after damage, such as trauma, surgery, or inflammation. Scar formation on the skin is a natural part of the wound healing process, i.e. regeneration process. Fibroblasts take the main part in this process, because It is these cells that synthesize collagen, which primarily consists of both our skin and scar tissue.

It must be said that the appearance of the future scar will largely depend on what happens to the wound, starting from the moment the skin is damaged - until the moment it is completely healed (this period is 2-3 weeks). It is during this period that the doctor has the opportunity to prevent excessive scarring. But as we said above, scars on the skin can occur not only as a result of injury, but also after inflammatory skin diseases. In this case, we mean scars after smallpox, chickenpox or acne on the face (Fig. 6).

Scars/scars: photo

Pathological scars with excess scar tissue (Fig. 2-3) most often occur after a wound becomes infected, if the wound was sutured with excessive tension on the sutures, or the wound itself was located in an area of ​​skin with high natural tension. We are talking about the neck, shoulders, sternum, areas of the body near the joints. Deterioration of the appearance of the scar can also be caused by late removal of sutures, as well as too long epithelization of the wound (more than 2 weeks).

Cream or ointment for scars and scars - can be used after complete epithelization of the wound surface, when the period of scar maturation begins. Typically this period begins 14-21 days after the wound occurs and will last from several months to an average of 1 year (depending on the size of the wound/scar). During the maturation period, the size of the scar begins to shrink, its redness decreases - due to a decrease in the number of capillaries. And it is during this period that scar cream is more likely to produce results.

Important: the main purpose of using ointment for scars and scars is to reduce the likelihood of pathological scarring (the appearance of hypertrophic scars). Below you will see that to date there is no scientific research that would unequivocally confirm the effectiveness of topical products for reducing scars. The results of clinical studies contradict each other, but researchers agree that the use of ointment for scars still increases the likelihood of a more favorable outcome.

Types of scars (scars) –

Scars on the skin are usually divided into several categories. There are normotrophic, hypertrophic, keloid and atrophic scars/scars.

• Normotrophic scars (Fig. 1) are flat, pale scars, which are an example of normal scarring (most patients experience these). They differ in that they are flush with the surface of the skin, or protrude very slightly above it. At first they will be red or dark red in color, but over time they will become increasingly paler and flatter.

• Hypertrophic scars (Fig. 2-3) - they are distinguished by the fact that they will noticeably rise above the skin level, plus they almost always have an intense red or purple color - due to the presence of a large number of capillaries. They begin to form 2-3 weeks after complete epithelization of the wound, and within 3-4 months their growth is noted (after which further correction downward is possible). By about 1-1.5 years, their sizes become stable and do not change further.
  Hypertrophic scar from cesarean section –

  Hypertrophic scars are an example of a pathological variant of tissue scarring and, as a rule, they are formed after skin incisions are made during surgical operations. Hypertrophy of scar tissue can be a consequence of infection of the wound, or when the surgeon sutured the wound with excessive tension on the surrounding tissue, or if the wound is located in an area of ​​the skin with high natural tension (neck, shoulders, near joints), etc.

• Keloid scars/scars (Fig. 5) – are formed as a result of excessive collagen formation at the wound site. The peculiarity of these scars is that scar tissue continues to grow far beyond the wound itself - even after the wound has already healed. Moreover, if hypertrophic scars are still capable of reduction and can be smoothed out over several years, then the size of keloid scars does not change over time.

• Atrophic scars (Fig. 6) - they look like indentations on the surface of the skin (minus tissue), i.e. located below the surface of the skin. This is what scars on the face look like after chickenpox or acne. The treatment of atrophic scars has significant differences from the treatment of other types of scars, and you can read more about this in the article at the link above.

Nutrition in the postoperative period

Surgery is a serious stress for the body. Stress greatly affects your metabolism. In order for the recovery processes in the patient’s body to suffer less, a careful approach to nutrition after surgery is needed.

Changes in metabolism after surgery or trauma are a risk factor for postoperative complications.

A patient's metabolic rate affects the speed at which he recovers from surgery or injury. If the body’s response to intervention is powerful, then the person becomes exhausted, the immune system weakens, and infection can easily develop. This complicates the recovery process. Why is this happening?

How the body reacts to surgery or injury

During surgery and trauma, stress hormones and cytokines enter the patient’s blood. Cytokines are substances that regulate inflammatory processes in the body. Inflammation is the body’s response to various injuries. This reaction activates the body's defenses - because any wound can cause infection. The release of cytokines and stress hormones into the blood changes metabolism. What are these changes? The process of glycogen breakdown starts - the body’s energy reserves are spent. Fats from adipose tissue and proteins from muscles are processed as additional sources of energy. Consumption of protein for energy needs does not allow it to be used for primary needs: the creation of new cells and tissues, i.e. wound healing. This interferes with the patient's recovery after surgery:

• When muscle volume has decreased, it is difficult for the patient to return to even minimal physical activity.

To improve the prognosis for the patient, it is necessary to supply his body with additional nutrients that provide easily digestible energy and protein. Prevention of general exhaustion has a positive effect on the immune system, increasing the defenses of the entire body. Even minimal nutrition has a healing effect on the cells of the intestinal mucosa, preserving the barrier function of the gastrointestinal tract against microbes.

Nutritional therapy - what is it? What are the indications for nutritional therapy in a surgical patient?

One of the components of supporting a patient on the path to recovery is nutritional therapy. This is nutrition for the patient, which is aimed at preventing or treating malnutrition. Nutritional therapy includes oral nutrition - a regular or therapeutic diet, enteral and parenteral nutrition.

Which surgical patient needs nutritional therapy?

- a patient without signs of malnutrition, if he is not expected to be able to eat for more than 5 days, or he will have problems taking enough food by mouth (less than 60% for more than 7 days)

- a patient who may be at risk of postoperative complications related to nutrition. Risk screening is performed when a patient has

• Body mass index (BMI) is less than 20.5 kg/m2
• Body weight loss greater than 5% in the last 3 months
• Reduced food consumption
• Serious condition
• Elderly age

Timely prevention of malnutrition significantly affects the outcome of the disease. How it looks in numbers - read the statistics below.

Some statistics from studies on the “prognostic impact of nutritional status on complications and mortality”

Early initiation of nutrition after surgery may be particularly questionable in the case of gastrointestinal surgery. But even here - subject to the rules of nutritional support - the percentage of complications and the time spent in the hospital are reduced. This is shown in a Cochrane review2 on the effect of early enteral nutrition on the incidence of complications after gastrointestinal surgery. Cochrane is a non-profit organization that analyzes published medical research and checks it against the principles of evidence-based medicine.

The review authors identified 14 studies, including 1224 patients. From these studies, they concluded that starting nutritional support within 24 hours of surgery shortens hospital stay by 1 day and reduces the incidence of some complications:

• Wound infection. In patients receiving nutrition, the risk was up to 13.4%, in controls who did not receive nutritional support - up to 33.3%
• Complications, suppuration of sutures. With nutritional support, the maximum risk fell from 27% to 8.3%
• Mortality. The risk of death decreased with early nutrition from 19% to 6.7%.

Special mixtures balanced in nutrients, vitamins and microelements are suitable as nutritional therapy.

Nutrien Stadard and Nutrien Energy products for restoring the body after surgery

Such mixtures include Nutrien Standard and Nutrien Energy. These are universal therapeutic products that are suitable for oral administration and enteral feeding through a tube after surgery and injury.

Both mixtures contain:

• milk protein, which is easily digestible,
• polyunsaturated fatty acids (omega-3), which contribute to anti-inflammatory and immunomodulatory effects,
• fats that do not overload the pancreas, are easily digested and provide quickly and a lot of energy,
• vitamins and microelements that accelerate all recovery processes in the body. Nutrien Standard is easier to digest and tolerate in the early postoperative period.

Nutrien Energy has a higher concentration of protein and energy, vitamins and minerals, and is better suited for later, long-term rehabilitation, when the gastrointestinal tract has recovered from surgical stress. Which of these mixtures is best? For an accurate answer, get recommendations from your doctor.

Nutritional therapy statistically improves a surgical patient's prognosis, but the nuances of nutritional support may vary from patient to patient. To get the most benefit from medicinal mixtures, it is important not only to understand how to organize your diet after surgery, but also to act in coordination with your doctor or nutritionist.

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How does scar formation occur?

Scar formation is a natural healing process of the skin after damage (Fig. 7). Initially, the wound surface becomes covered with crusts, and the traumatic defect itself begins to be filled with soft granulation tissue. Gradually, the granulation tissue is replaced by dense fibrous connective tissue (collagen), which is produced by cells called fibroblasts.

Fibroblasts actively produce collagen at the site of skin damage for 3-4 months, which usually leads to a gradual elevation of the scar above the skin level and the formation of a bumpy surface. At the same time, blood capillaries actively grow, causing the scar to become red. Over time, the over-formed collagen begins to gradually break down, and the number of capillaries decreases (the scar decreases in size, becomes smooth, less hard and more elastic, less red).

The period of scar maturation - we have already said above that external cream or ointment for scars and scars - can only give an effect if they are used during the period of scar maturation, during which the scar undergoes active transformation. For example, if at the beginning of this period the scar only increases in size and becomes redder, then over time its reverse transformation begins to occur. Gradually, the scar decreases in size (due to the degradation of excess collagen), and after an average of 7 months it begins to fade due to a decrease in the number of capillaries.

The period of scar maturation begins from the moment of complete epithelization of the wound surface (when there are no longer crusts), and will last on average up to 1 year. But in some patients this period can take only 4-6 months, and in rare patients it can take up to 2 years, and this difference in time depends on several factors. For example, the size of the original wound/scar size, whether there is skin tension in the scar area, and age (patients under 30 years of age have a slower rate of scar maturation than patients over 55 years of age).

Important: Clinical studies show that the slower the rate of scar maturation, the worse its final appearance.

How to get rid of scars -

How to get rid of scars will depend on the type of scar, as well as its age. There are several treatments that can help make them less noticeable and improve their appearance. Keep in mind that, unfortunately, it is hardly possible to improve, but completely get rid of scars without a trace.

In this section of the article we will focus on –

• cream for scars and scars (Dermatix, Kelo-Kote),
• silicone bandages (plasters),
• scar massage and pressure bandages,
• laser scar removal,
• surgical removal of scars.

Also used to treat scars are:

• medium or deep chemical peeling,
• dermabrasion technique (skin resurfacing),
• cosmetic camouflage (make-up or tattoo on scars).

The best external remedy for scars and scars -

We have already said above that external preparations will be effective only if they are used during the period of scar maturation (24stoma.ru). Moreover, an ointment or cream for scars and scars must be used for at least 2-3 months before you can notice the first results. If you missed the period of scar maturation, then external remedies will not be effective and you will need more radical treatment methods (for example, laser). Let's look further at what external means we can use to get rid of scars.

1) Remedies for scars and scars based on silicone -

Scar products based on medical silicone have been used since approximately 1983. Silicone gels work on the principle of occlusion and hydration. After applying silicone to the surface of the skin, it is absorbed, leaving an invisible “occlusive bandage” on the surface (this layer prevents the evaporation of water from the surface of the skin/scar, but at the same time allows air to pass through). As a result, this increases the hydration of scar tissue, i.e. saturating it with water reduces the growth of blood capillaries.

As a result, this has a positive effect on the restructuring of the scar during its maturation, which increases the likelihood of reducing its size (while simultaneously improving such indicators as elasticity and extensibility). The hardness of the scar decreases, its color improves, and itching decreases. It must be said that in addition to silicone gels, there are also special silicone dressings that are worn from 12 to 23 hours daily - for several months.

• Gel Dermatix (USA) – costs 2,400 rubles per 15 g tube.
• Kelo-Coat gel (USA) – price 2400 rubles per 15 g tube.
• Zeraderm Ultra - price about 5,000 rubles per 20 g tube (this is an analogue of the first two drugs, but with a richer composition, which, in addition to silicone, additionally includes coenzyme Q10, vitamins A and E, as well as SPF 15).

The silicone dressings we talked about above are made on a fabric basis and are translucent. They have multiple uses, i.e. you don't need to change it to a new one every day. Silicone dressings come in specific sizes, but you can cut the size you need with scissors. The silicone bandage should be on the skin for 13 to 23 hours daily; it can only be removed for antiseptic treatment of the skin and the bandage itself.

• Dermatix silicone dressing - price from 1,400 rubles (size 4x13 cm), about 5,000 rubles (size 13x25 cm).

2) Scar remedy based on onion extract –

Onion extract is used in the treatment of burns, hypertrophic and keloid scars. It contains the flavonoids quercetin and kaempferol, which have an inhibitory effect on fibroblast proliferation and collagen production, which directly affects the formation of scar tissue. In addition, onion extract increases the expression of MMP-1 (matrix metalloproteinases, which belong to endopeptidases - enzymes that destroy the extracellular matrix of connective tissue).

Matrix metalloproteinases tend to destroy newly formed pathological collagen, which makes up scar tissue. An example of a drug with onion extract is the Contractubex gel. It also contains sodium heparin, which increases the hydration of scar tissue, i.e. saturating it with water. The drug Contractubex (Germany) costs only about 600 rubles for a 20 g tube and about 1000 rubles for a 50 g tube.

3) Products with proteolytic enzymes –

There is a Russian drug Fermenkol, which contains a complex of proteolytic enzymes (collagenolytic proteases), as well as sodium heparin. It is understood that these enzymes should destroy the excessively formed pathological collagen that makes up hypertrophic and keloid scars. Fermenkol gel costs from 1,500 rubles per 30 g tube, but there is also a form in the form of a solution (for electrophoresis).

There are clinical studies that show that enzymes penetrate the skin quite poorly due to the large size of the molecules. Therefore, the most effective method is the use of Fermenkol solution in medicinal electrophoresis procedures (this method significantly increases the penetration of enzymes into the rumen). The phonophoresis technique with gel will be slightly less effective, and the most ineffective method is conventional gel applications. Therefore, it is better to use gel applications only during breaks between electrophoresis courses, and not as monotherapy.

Review of the best ointments for healing sutures after surgery

Consider the list of the most effective ointments used for wound healing:

Important!
Before applying the ointment, treat the damaged area of ​​skin with an antiseptic - this will reduce the risk of inflammation and suppuration. If an allergic reaction occurs and there is no positive effect after a week of using the chosen product, consult a doctor and select another medication to remove postoperative sutures.

When treating uninfected sutures, use emollients, immunostimulating and regenerating agents; in the case of suppuration, therapy should consist of ointments with anti-inflammatory, antiviral and bactericidal effects.

Scar cream: reviews of effectiveness

It makes no sense to search the Internet for reviews of ointment or cream for scars and scars, because... At the moment, almost 99% of all reviews on forums are hidden advertising and anti-advertising. There are hundreds of marketing agencies in Russia, whose thousands of employees (under the guise of consumers) write posts on forums about medications, cosmetics, toothpastes and other various products. Therefore, we will use the results of published scientific studies, which are available on the website of the National Library of Medicine.

In general, clinical studies (source) show that silicone-based products are indeed capable of somewhat reducing the volume of scars, reducing their hardness and increasing elasticity, as well as improving the color of hypertrophic scars and keloids. When used prophylactically on the area of ​​surgical incisions, products with silicone are highly likely to prevent the development of pathological types of scars that occur with hyper-formation of scar tissue.

Regarding the effectiveness of drugs based on onion extract, there are 2 very large clinical studies (source), in which 771 and 1269 people took part. The study showed that Contractubex also led to an improvement in the appearance of hypertrophic and keloid scars, and when used prophylactically immediately after epithelization of the wound, it increased the likelihood that the scarring will not be pathological.

However, there are comparative studies of the effectiveness of products with silicone and onion extract. For example, “Comparison of efficacy of silicone gel, silicone gel sheeting, and topical onion extract including heparin and allantoin for the treatment of postburn hypertrophic scars” 2009, authors – Karagoz H., Yuksel F.. (translation – “Comparison of effectiveness silicone gel, silicone gel coating, and topical onion extract, including heparin and allantoin, for the treatment of hypertrophic burn scars.” This study concluded that onion extract formulations were slightly less effective than silicone gels and silicone dressings.

In addition, we found 2 more studies interesting, which concluded that combination therapy (a drug with silicone + onion extract) gives a more pronounced result in improving the appearance of the scar than treatment with any of these drugs separately. This is stated, for example, in the study “Contractubex® and Silicone-gel sheeting to treat keloid and hypertrophic scars concluded that co-administration led to the best response”, authors – Hosnuter M., Payasli C..

Conclusions: There are actually many more clinical studies, and some of them provide conflicting results. But in this review, we tried to present only studies with high 1-2 levels of evidence (in total there are from 1 to 5, where 1 is the highest), and in which a large number of subjects took part. Therefore, we can conclude that products with silicone and onion extract do increase the likelihood that the appearance of the scar will be better than when these products are not used.

Well, the last thing about the Russian remedy Fermenkol. Unfortunately, there is no information on the effectiveness of this drug in the Cochrane Research Library. Clinical studies were carried out only at the local level, but they show (source) that a good result can only be obtained by using Fermenkol solution in drug electrophoresis procedures (and the effect will be visible after the 1st course of treatment of 10-15 procedures), or using phonophoresis technique with gel.

The use of conventional gel applications (in the form of monotherapy) gives a very mediocre, statistically insignificant result. We hope that this argument of ours has helped you understand which ointment for scars or cream for scars and scars will be better.

How to prevent scars -

It's impossible to completely prevent scars from forming, but there are a number of things you can do to help your scar become less noticeable and heal better...

1. If a wound forms on the skin, immediately clean it of dirt and disinfect it.
2. If the wound is deep, use a pressure bandage to bring the edges of the wound closer together.
3. Contact your surgeon/traumatologist immediately.
4. Always protect the wound from water (do not wet wounds with water) until the wound is completely epithelialized and the last scabs fall off. This rule applies to any type of wound, including wounds from surgery with sutures.
5. Do not pick at the wound or tear off the scabs under any circumstances, as... this will definitely lead to the formation of a significant scar.
6. If the wound (sutured surgical wound) is located in a place where the skin has tension (neck, shoulders, near joints, etc.) - it is very important during the entire healing period, as well as for a long time after, to use tapes to reduce tissue tension . Tapes are tapes that resemble an elastic adhesive plaster. Reducing tissue tension in the wound area (ripening scar) will significantly reduce the risk of the formation of hyper-volumes of scar tissue.
7. After complete epithelialization, use any remedy for scars and scars. This can be a special ointment for scars and scars based on onion extract, or a silicone-based gel/plaster (which is more effective), or a combination of both (which is even more effective).
8. Gently massage the scar area as the scabs fall off after healing. Massage helps prevent the formation of excess scar tissue.

How to reduce post-operative pain

Experts include the following tasks for postoperative pain management:

• quality recovery period,
• acceleration of rehabilitation and discharge from hospital,
• reduction in the number of complications, including the development of chronic postoperative pain.

The most effective is the so-called multimodal scheme4 of postoperative pain relief, the concept of which involves the use of an optimal combination of drugs from different groups in minimal doses4.

Groups of drugs that are used as painkillers after surgery:

1. Opioid analgesics. Traditionally, they were considered the basis for surgical anesthesia, but their isolated use gives the expected result in only 25-30% of cases4, and the introduction of the maximum effective dose is associated with a high risk of side effects4, including respiratory depression. Also, after their withdrawal, even greater pain sensitivity often occurs.
2. Nonsteroidal anti-inflammatory drugs (NSAIDs). The formation of postoperative pain syndrome is directly related to tissue injury and inflammation. Therefore, the prescription of NSAIDs, as drugs that have a powerful anti-inflammatory and analgesic effect, is indicated from the first minutes after surgery, and sometimes during surgery.

They act directly on the cause of the development of hypersensitivity, namely the production of prostaglandins and other biologically active substances involved in the inflammatory process. There are methods that suggest using NSAIDs 20-30 minutes before the incision, which can reduce the intensity of pain in the area of ​​postoperative sutures.4

When prescribed with drugs from the previous group, NSAIDs make it possible to reduce the dose and enhance the effect of opioids and prevent their side effects4.

1. Non-opioid centrally acting painkillers. They do not affect the mechanisms of inflammation, but are able to suppress secondary increased pain sensitivity at the level of transmission of nerve impulses. Their use half an hour before the end of the operation ensures a calm and painless awakening after anesthesia4. They have proven themselves well in complex pain relief.
2. Drugs that affect the perception of pain. Introduced to prevent hypersensitivity and the development of chronic pain syndrome4.
3. Regional anesthesia (analgesia). The application of the method is based on interrupting the flow of pain impulses from the damaged area to the spinal cord and brain4.

For each patient, a comprehensive pain relief regimen is selected individually. Factors such as age, gender, extent of surgical intervention, concomitant pathology, mental characteristics, sensitivity to pain and its presence before surgery are taken into account.

Up to contents

Pressotherapy and massage in the treatment of scars –

Pressotherapy involves the use of compression bandages.
The fact is that mechanical pressure exerted on the scar leads to compression of the capillaries in the scar tissue and accelerates the maturation of the scar. Compression bandages have been used for many years as the standard of care for the treatment and prevention of severe burn scars. Unfortunately, compression garments can be uncomfortable and unsightly, making it difficult for patients to adhere to treatment. Pressotherapy should begin to be used at an early stage of the scar maturation period, and pressure on the scar should be applied for at least 23 hours a day (for at least 6 months) - while the scar maturation period lasts. However, such treatment can be started no earlier than the wound is completely epithelialized. Compression “garments” can take the form of bandages, elastic sleeves, gloves, stockings and suits.

Massage of scars and scars - can be effective especially on post-operative scars, and will be a good addition to topical products based on silicone and/or onion extract. It is believed that massage accelerates the maturation of collagen, promotes the restructuring of scar tissue, and also leads to an increase in the elasticity of the scar. You can start massage only after complete epithelization of the wound (when the last crusts fall off). But keep in mind that the massage should not be harsh, because... The strength of scar tissue is inferior to that of intact skin.

Laser scar removal: prices, before and after photos

Laser scar removal is carried out using a procedure called laser skin resurfacing. This method is suitable for mature scars whose size has stabilized and is no longer increasing. Laser resurfacing works well not only with hypertrophic and keloid scars (for example, a cesarean scar can be almost completely removed with a laser), but also with shallow atrophic scars after acne.

Laser scar removal: before and after photos

What lasers can be used:

• Fully ablative lasers – fully ablative “carbon dioxide CO2 laser” and “erbium Er:YAG laser” – can improve the condition of hypertrophic and keloid scars by 50-81% after just 1 procedure.
  However, this type of laser is quite traumatic, and re-epithelialization of the laser-treated skin flap will last 7-10 days (for CO2 laser) and 4-7 days (for Er:YAG). Er:YAG laser is less traumatic for tissue, but requires more procedures to achieve a similar effect - compared to a CO2 laser. We do not recommend the use of these types of lasers - not only because of the long rehabilitation period, as well as a large number of side effects, but also because of the fairly high percentage of relapses of hypertrophic and keloid scars.

• Fractional ablative lasers - when using conventional ablative lasers, which we described above - absolutely the entire surface of the skin flap is subject to thermal damage. But ablative fractional CO2 or Er:YAG lasers act on the skin fractionally (i.e., between micro-areas of thermal damage there will be areas of undamaged skin). This can significantly reduce the rehabilitation period and reduce the risk of side effects. Many patients note that fractional ablative lasers allow them to achieve a more aesthetic appearance of the scar - compared to completely ablative lasers.
• Pulsed dye lasers (PDLs) – they are non-ablative lasers, i.e.
  they leave the surface of the skin intact, and all areas of thermal damage occur in the deep layers. For the treatment of hypertrophic and keloid scars, ILCs with a wavelength from 585 to 595 nm are used, for example, the VBeam Perfecta laser. These lasers greatly reduce the vascularization of scars (the number of blood capillaries), which determines their bright red/purple color. They also significantly reduce the height and thickness of hypertrophic and keloid scars. For example, in the authoritative scientific journal “Dermatologic Surgery” in 2016, clinical studies were published that showed that the severity of hypertrophic scars after 1-2 sessions of ILC decreased immediately by 57–83%. It should also be noted that the risk of relapse after ILC was the smallest - in comparison with all other types of lasers. In our opinion, ILCs are the optimal choice for the correction of hypertrophic scars and keloids, however, in this case, a larger number of procedures may be required.

Laser scar removal (ICL, fractional ablative) –

Laser scar removal: prices Cost varies depending on the area where the scar is located, as well as its size. Therefore, to remove scars with a laser, the cost per 1 cm2 will average about 1,800 rubles (the upper price limit is up to 3,000 rubles).

Possible side effects after the procedure -

• pain, burning (disappears within 12-72 hours),
• swelling (disappears within 48 hours),
• bleeding (disappears within 12 hours),
• formation of crusts, peeling (within 5-7 days),
• complete healing after laser scar removal – 10-21 days,
• risk of pigmentation,
• risk of infection,
• risk of scar re-formation.

Reasons affecting the speed of healing

Each person's postoperative sutures heal individually. There are a number of reasons that influence this:

• Age. Over the years, the process slows down more and more; sutures heal fastest in young patients.
• Weight. Excess weight will become an obstacle to rapid healing, and all because blood circulation has worsened.
• Diet. Lack of fluid in the body and poor nutrition slow down the healing process.
• Immunity. If there are any disturbances in the immune system, the healing process may be delayed.
• Type of scar. Normotrophic and atrophic scars heal better than hypertrophic and keloid scars.

Surgical treatment of scars –

Surgical treatment of scars involves excision of scar tissue and creation of a cosmetic suture. There are various methods of tissue suturing (for example, intradermal), which make it possible to ensure that the seam will be practically invisible in the future. For cosmetic stitches, very thin suture material is used.

How to get rid of scars at home -

It all depends on your perception of the “magnitude of the problem.” If the scar/scar causes you significant concern and you want to get a quick result, it is best to use combination therapy (for example, silicone dressings or Dermatix gel + electrophoresis or phonophoresis with the drug Fermenkol). Unlike electrophoresis, phonophoresis with Fermenkol can be done at home, which is possible using special inexpensive devices that are sold in any online store.

Another option is a combination of silicone gel/plaster and Contractubex. To get rid of scars at home, you will have to be patient. Of course, you will be able to achieve faster results by combining a silicone patch or gel with the phonophoresis/electrophoresis method of the drug Fermenkol. In this case, you will be able to see the result after 1-2 courses (1 course of electrophoresis or phonophoresis consists of 10-15 procedures daily, the interval between courses is 7-10 days). If you use only gels or silicone patches, the first results may be noticeable only after a few months.

Additional tips to improve the appearance of scars –

• Avoid exposing the scar to sunlight, as... this slows down the healing process and makes the scars more noticeable in color. If the scar is located on an area of ​​skin exposed to the sun, then use sun protection (SPF 30-50) every time before going out into the sun.

• Massage the scar area every day (at least 2 times a day for 3-5 minutes) to avoid excessive formation of the rough fibrous tissue that scars are made of. You can do a massage either without anything or using oils or gel with silicone (see brands above).

• Continuously exfoliate the surface layer of skin, which consists of dead skin cells, using superficial chemical peels. It also reduces the risk of rough scars forming.

Wound healing

The general pattern and characteristics of wounds remain unchanged over the centuries. But approaches to their treatment underwent significant changes as medicine developed: the more doctors understood the mechanism of wound healing, the more effective treatment methods became and the better results were achieved. Detailed knowledge of the physiology of the wound process allows today's surgeons to choose the most appropriate local treatment options. The main principle of choice is to satisfy the specific needs of the wound at each of its three stages, which, regardless of the type and degree of damage, are characterized by certain morphological characteristics of cells and tissues. At the present stage, the main help of surgeons is a wide variety of ready-made medical dressings.

The first stage is inflammation

From the moment of injury, the inflammation stage begins, which lasts 3-4 days.
The body's first task at this stage is to stop the bleeding. Its solution is achieved by short-term vasospasm and slowing down blood flow: a fresh blood clot stops bleeding. The second task is to clean the wound from damaged and dead tissue cells that can become a source of infection. To do this, the body includes a complex of complex cellular reactions. Show in full

Special cells migrate into the wound and absorb elements of dead tissue and bacteria. They also produce biologically active substances. Blood pressure increases in microvessels due to its active inflow and difficult outflow. As a result, the permeability of the vessel walls increases, the liquid part of the blood enters the inflammation site and an inflammatory fluid is formed - exudate. Externally, the inflammation stage is manifested by local swelling, pain, specific discharge and redness of the skin around the wound.

The priority task of local treatment at the first stage of the wound process is to help cleanse the wound and remove exudate, which is sometimes very abundant. The best way to cope with this is therapeutic absorbent dressings with a special lipid-colloid complex. When applied to a wound, they ensure the outflow of exudate and create the most favorable conditions for its healing.

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Second stage - regeneration

If the wound tissue has retained its vitality, its edges are in close contact and suppuration has not begun, from the third day the wound process enters the stage of regeneration (proliferation). At this stage, the most important role is played by special cells - fibroblasts. Their function is to synthesize the protein collagen, from which connective tissue fibers are formed. In the process of sprouting fibers with capillaries and restoring the patency of lymphatic vessels, young scar connective tissue is formed at the wound site.

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Taking into account the characteristics of the second stage of wound healing, the main task of local treatment at this stage is to ensure optimal fluid content in the wound and protect easily injured young connective tissue from damage. The solution to these problems is fully provided by ready-made therapeutic hydrocolloid dressings, the peculiarity of which is the formation of a protective gel upon contact with the wound.

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Third stage

At the same time, the epithelium, the cells of the surface layer of the skin, grows. Thus, the wound healing process enters the third stage - epithelization. Postoperative and small incised wounds, the edges of which are no more than 1 cm apart, heal by so-called primary intention in 3-7 days. The skin scar is even, smooth and almost invisible.

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In the case of suppuration of the wound, the presence of cavities or drainage tubes in it, as well as if it is impossible to bring the edges of the wound together after tissue excision, healing is carried out by secondary intention. Its characteristic feature is the filling of the wound cavity with many granules closely pressed together, consisting of small branches of capillaries surrounded by connective tissue cells and leukocytes. This red, fine-grained mass, called granulation tissue, lines the entire wound cavity, forming a temporary covering and protecting it from external damage. Subsequently, layers of epithelium grow on the granulation tissue, gradually covering the entire wound surface. The scar protrudes slightly above the surface of the skin and has a red color that fades over time.

At the stage of epithelization, wound healing is facilitated by ready-made therapeutic lipidocolloid dressings with a polymer mesh base. Their most important property is atraumaticity, which is achieved by the combined action of soft paraffin and the resulting gel. When using these dressings, epithelization is accelerated, and young connective tissue is not injured during dressing.

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The duration of wound healing depends on their nature, character, size, general condition of the body, and can reach many months. At the same time, the stages of the wound process that smoothly replace each other cannot always be defined with clear deadlines, since wound areas may be at different stages of healing.

The strength of the wound increases gradually: in the absence of complications, by the second month the wound reaches 50% of its final strength, by the third month 75% of the initial strength is restored, and by the end of the sixth month - 95%.

Every wound has a natural healing potential that can be stimulated through the selective application of modern technology. The importance of optimizing the wound healing process cannot be exaggerated: during the year 17.4 million operations and 6.8 million surgical procedures will be performed in the Russian Federation, 22.2 million people are being treated with acute wounds, 5.2 million with chronic ones (2015). .).

Treatment of scars with alternative means -

Let's say right away that these are not very effective treatment methods if we consider them as the main method of treatment. For example, we can talk about applying various oils to the scar - simultaneously with its massage. You can also use a product such as Aloe Vera, or exfoliating agents with fruit acids (for the latter, some use lemon juice or diluted apple cider vinegar).

For hypertrophic scars, it is really necessary to help desquamate the stratum corneum of the epidermis. But all these are only minor means that will not “make a difference”, but will only be a good addition to the drugs and treatment methods that we described above.

Aloe vera

Aloe Vera is a natural, herbal remedy for scars and scars, which has anti-inflammatory and antibacterial effects. It works as an emollient that helps the healing process and promotes the growth of healthy cells, improving skin texture.

How to use - First, peel off the outer layer of the Aloe Vera leaf until a jelly-like substance appears. After this, apply the gel to the scar, massaging the scar in a circular motion until the Aloe Vera is completely absorbed. After 30 minutes of this, wash off the remaining aloe vera with water. Apply Aloe Vera gel 2 times a day and you may see results in 3-4 months. Important: Aloe Vera should not be used on open wounds.

Lemon

Lemon contains alpha hydroxy acids, which have a chemical peeling effect. As a result, lemon juice removes dead skin cells, promotes the growth of new cells, and improves skin elasticity.

How to use: Apply lemon juice to the scar (if your skin is sensitive, you can dilute the juice with water or oil). Wait 10 minutes and rinse with warm water. The procedure should be repeated once a day. Keep in mind that lemon can discolor your skin and make it very sensitive to sunlight. Therefore, be sure to apply sunscreen or hide this area of ​​skin from the sun to avoid hyperpigmentation.

Apple vinegar

Just like citric acid, malic acid is an alpha hydroxy acid that is used for chemical peeling of the skin. Therefore, it will also help exfoliate and remove dead skin cells.

How to use: Mix equal amounts of apple cider vinegar and water. Apply this solution to the scar using a cotton swab. Leave on for 5 minutes and then rinse with water. Repeat once a day.

Important : Keep in mind that exfoliators based on lemon or apple cider vinegar will be much less effective than special exfoliating skin creams containing alpha hydroxy acids (which also have a moisturizing effect).

Tea tree oil

Tea tree oil reduces scars and blemishes on the skin due to its anti-inflammatory and healing properties. Just keep in mind that you should never use tea tree oil undiluted.

The first use is to add 4 drops of tea tree oil to 2 tablespoons of water. Wet the scar with this solution 2-3 times a day.

The second option is to mix 2-3 drops of tea tree oil with 1 teaspoon of almond oil. Apply this mixture to the scar and leave for 30 minutes before rinsing with water. Use once daily.

Sources:

1. National Library of Medicine (USA), 2. Cochrane Library (Cochrane Library for Scientific Research), 3. National Center for Biotechnology Information (USA), 4. The composition of the products was taken from the official websites of the manufacturers.

Classification of drugs that promote wound healing

Drugs that promote wound healing include:

• vitamin preparations: dexpanthenol;
• hyaluronic acid preparations: zinc hyaluronate;
• herbal preparations: sage, calendula, larkspur, gray alder, sticky alder, Japanese sophora, cinquefoil, yarrow;
• preparations of animal origin: deproteinized hemoderivative from the blood of dairy calves, propolis;
• other wound-healing drugs: methyluracil, thiotriazoline.

In addition, there are combination products that contain wound-healing drugs along with antibiotics and antiseptics that are used for infected wounds: methyluracil + chloramphenicol; dexpanthenol + chlorhexidine; methyluracil + miramistin.