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 Dr. Atiyeh |
MOISTURE IS KEY "There are several ways to approach a post-operative wound, but in my experience, maximizing aesthetic outcomes can be best achieved when moist environment for optimal wound healing is provided," says Bishara S. Atiyeh, M.D., F.A.C.S., general secretary of the Mediterranean Council for Burns and Fire Disasters (MBC) and clinical professor of the Department of Plastic and Reconstructive Surgery at the American University of Beirut, Lebanon.
"Moist wound dressings allow for optimal healing conditions, as wound healing can occur at a faster rate compared to dry conditions," Dr. Atiyeh tells Cosmetic Surgery Times .
Dr. Atiyeh conducted two studies comparing the effects of various wound dressing techniques on re-epithelialization1,2 of partial thickness skin-graft donor sites and a third study on primary wound healing of facial lacerations.³ (A) Split thickness skin graft donor site. (B) Half of the donor site covered with MEBO (left) and the second half covered with Sofra-Tulle and gauze (right). (C) Superior scar quality observed in the MEBO-treated area at three weeks (D) and at 10 weeks. |
"One of the main goals of good wound healing is the unhindered migration of keratinocytes, one of the cornerstones in the wound healing process. This free-flowing migration can best be achieved when the wound remains moist. Furthermore, this much-needed wound moisture allows cytokines, inflammatory cells and other growth factors to implement their beneficial effects on wound dermal healing and re-epithelialization," Dr. Atiyeh explains.
STUDY STATS In one of the studies comparing dressing techniques,1 semi-open Sofra-Tulle (antibiotic-impregnated Vaseline gauze) versus MEBO, results showed complete re-epithelialization within five to six days in the MEBO-treated areas while the areas treated with the Sofra-Tulle dressing required 10 to 12 days to heal. The MEBO-treated areas were markedly less hyperemic and demonstrated less post-inflammatory hyperpigmentation.
In the second dressing technique study,2 Tegaderm (3M; St. Paul, Minn. ) and MEBO were compared, and the MEBO-treated wounds showed earlier anatomic healing with a significantly superior cosmetic outcome over a six-month follow-up period compared to the Tegaderm-treated wounds. According to Dr. Atiyeh, these results show that an early physiologic cutaneous barrier functional recovery is imperative in achieving an improved scar quality, as improved function and improved cosmetic result go hand in hand.
"One of the advantages with the MEBO is that it offers optimal moisture with good breathing properties, as well as adequate drainage compared to both the nonmoisture-retaining Sofra-Tulle dressing and the occlusive Tegaderm dressing," Dr. Atiyeh observes. He adds that the functional healing as measured by trans-epidermal water loss seen in the Tegaderm-treated wounds was significantly slower compared to MEBO-treated wounds.
"This suggests a more rapid epithelial maturation and stratum corneum formation that cannot be explained only by the mere fact of moisture preservation. It may be due to a positive action of the moisture-retentive ointment promoting more rapid maturation of the regenerating keratinocytes," Dr. Atiyeh relates.
In the third clinical study,3 which compared Fucidin (Leo Pharma; Copenhagen, Denmark), an antibacterial ointment, or no therapy of primary closed wounds with MEBO, he says that the results clearly show the prophylactic beneficial effect of the ointment on primary healing of surgically repaired wounds.
"Moist dressings such as MEBO offer the advantages of a moist environment for wound healing by simple ointment application without the need for an overlying secondary cumbersome, bulky and expensive dressing."
