David J. Leffell, MD, is a Professor of Dermatology and Professor of Otolaryngology and Plastic Surgery at Yale School of Medicine. He has written about wound care after surgery. Here is what he has to say about healing and wound care after surgery:
The inflammatory phase of healing begins about twelve hours after surgery and lasts for approximately five days. Adequate blood flow to the wound site is what ensures that the wound is healing. Blood is the magic potion that carries special cells, chemicals that first staunch the flow of blood by constricting vessels in the area, and platelets to plug up any leaks. If germs do gain a foothold in the wound, infection results. Infection is rare on the face or scalp where the blood flow is robust. In other areas, such as those farthest from the heart, like the legs and feet where blood flow can be more sluggish, the risk of infection is greater.
Proliferation begins about a day after surgery while the inflammation phase is still in progress and continues for about a week. It is during this phase that fibroblasts divide rapidly in preparation for spewing out the bundles of new collagen. At this stage, a variety of cells combine with collagen to build scaffolding upon which the more permanent scar tissue will be built. Maturation refers to the slow process of remodeling the final scar. Although sufficient scar tissue forms within a few weeks, so that any sutures can be removed safely, the body continues to work hard laying cables of collagen and reconfiguring the scar.
After two months the scar may still have a reddish, raised appearance, which can persist for a full year. The body’s own natural refinement of scars continues, on average, for a full year, so in the world of cosmetic surgery and reconstructive surgery, no final judgments are made about the need to fix an imperfect result until the body has gotten its last licks in. In time, even the most thickened red or purple scars will become pale and flat.
WOUNDS HEAL BEST WHEN KEPT MOIST
It has been proven that moist wounds of the skin will heal up to 50 percent faster than wounds that dry out and develop a scab.
FOR SCRAPES, CUTS, AND SURGICAL WOUNDS:
- Clean the wound daily with tap water. Don’t use hydrogen peroxide. (The bubbles make it look as if something good is happening, but in fact, in the test tube, hydrogen peroxide can injure or kill cells.)
- Apply a thin layer of antibiotic ointment such as Polysporin or Bactroban. Don’t overdo it, since prolonged use of the former can result in an allergic rash.
- After the first week, plain petroleum jelly (Vaseline) or Aquaphor works well to keep the wound moist.
- Cover the wound with a Band-Aid or other nonstick dressing. Don’t use gauze-the fibers can get in the wound.
- Once the wound has healed and you can see new skin growing over it, you can discontinue the ointment.