Surgical repair & healing

And when wound healing isn't optimal, dermatologists have many surgical repair options, with fractional photothermolysis showing great promise.

"Wound healing and re-epithelization occurs better in a moist environment than in a dry environment," Dr. Weinkle tells Dermatology Times.

The newer products that Dr. Weinkle and others are using postoperatively, should bleeding occur, include Surgicel (Johnson & Johnson), which when applied to the top of the wound, gets absorbed and helps with hemostasis.

It is also important for optimum wound healing to avoid allergic contact dermatitis. For this, Dr. Weinkle uses Biafine (Ortho Neutrogena) postoperatively because it has been shown to stimulate re-epithelization and has a low incidence of contact dermatitis.

Furthermore, Biafine induces macrophage migration into the wound area to enhance healing, says Suzan Obagi, M.D., assistant professor of dermatology, University of Pittsburgh Medical Center (UPMC), and director of UPMC's Cosmetic Surgery and Skin Health Center in Pittsburgh.

"This is a newer topical agent. I have seen it make an incredible difference when we use it to help with wound healing after skin resurfacing," Dr. Obagi says.

When she cannot get a clean base on a wound, regardless of how much debriding she does, Dr. Weinkle uses Panafil (Healthpoint), an enzymatic copper complex, which is a chemical debrider.

To address slow-healing wounds, Dr. Weinkle uses Mepilex (Mölnlycke Health Care), a wafer-like silicone weave that she applies to the wound and leaves in place for two to seven days. Once there is a healthy bed of granulation tissue, Dr. Weinkle often applies Mepitel (Mölnlycke Health Care), a silicone foam dressing, which further stimulates granulation.

"You can apply that to a granulating wound when it is still in the healing stages, but has not yet formed epithelial skin," she says.

SAF-gel (ConvaTec), a seaweed alginate, also helps to stimulate granulation tissue and can be applied topically to a healing wound, Dr. Weinkle says.

Dr. Weinkle says that there are several products to maximize healing and diminish scar formation once the wound has healed. Kelo-cote (Advanced Bio-technologies) is a fast-drying silicone gel and that helps prevent scarring.

"We use it on the face and start it the day we take the stitches out. I have used this product on four different Mohs patients and they had great results," Harriet Lin Hall, Dr. Weinkle's nurse practitioner, says.

Silver alginate products are up-and-coming on the wound healing scene, according to Ms. Hall.

Scar repair

If wound healing isn't optimal, the dermatologist may have a scar to deal with.

The first step in successful surgical scar repair, according to Dr. Obagi, is to properly categorize the scar.

"It is not good enough anymore to treat every patient's scar with a single laser," Dr. Obagi says. "It is best for the dermatologist to determine whether it is a red, keloid, hypertrophic, atrophic, valley-shaped, box or icepick scar."

Dermatologists did not have many options for treating incisional scars in the past.