Dr. Sam Lam Plastic Surgery Forum

Hello Doctor

I enjoyed very much your posts in the blog concerning "different perspectives". They give food for thought, thank you!

A very general question concerning any procedure or circumstance that creates a small wound (from a cut to a peel, TCA Cross a small wound in the site of an injection, anything!)...

What is the right way to take care of a wound? Online sources seem to not agree on whether or not one must let a scab form and just let it fall naturally.
Others say the wound should be covered so a scab does not form.
Some indicate to leave it alone (the scab or wound as it heals), some, to put an antibiotic or vaseline over it all along.

I am not talking of one specific procedure, but in general, of wounds and how to avoid scars.
Who is right? which of the two approaches (allow scab to form or not, use ointment or not, or use ointment and cover?? what of all of those) should one follow?

Hugsssssss

Thanks for enjoying my blogs. NOW, WHO THE HECK SAID TO LEAVE A SCAR THERE? Oh my God. Sometimes, I have to put my foot down. There are a lot of gray areas in PS but this really should not even be remotely gray. If you leave a scar over an open wound, it will lead to irregular contracture where the new epithelium has to grow under the new scar, which will lead to most likely a very ugly scar. However, early capture with a thick thick emollient will provide a scaffold for the new skin to form evenly and smoothly. the epithelialization process will occur smoothly. As far as using antibiotics, I usually do like to use oral antibiotics if it is a sizable wound. e.g., I did a plasma skin resurfacing this morning and will do one tomorrow as well. Each individual will not apply an antibiotic cream but take a oral antibiotic to minimize a staph or pseudomonas infection. When the wound is small like an abrasion or cut on the face and the injury is clean, oral antibiotics is overkill. if it is a dirty wound, then perhaps still good. If it is a surgically created wound, whether to use antibiotic-impregnated solution versus just a plain emollient is up to the physician. The trade off with antibiotic solutions is that they can engender an allergic reaction in about 10% of users showing up 2 to 3 days after initial exposure. So with the luxury of time, it is best to do a spot test with an antibioitic ointment 3 days prior just to make sure. In any case, an emollient is important until the wound is fully epithelialized.

Great answer, super duper clear!

It is scary how one can find contradictory info, sometimes plain bad info on the net... glad there are people like you to straighten things up!

Great. I usually am very open minded with my answers but there is no question in my mind about my answer on this one.

Thanks for clearing this up Dr. Lam!

My step mom is a nurse and said something a long time ago about scabs being bad and I was always confused about what she meant. I thought she was talking about removing a scab and that didn't seem right to me. Now I know she meant not to let the scab form in the first place.

I assume that with my post-op paperwork I will receive instructions on how to care for the incision site after my mole excisions. I don't want to do anything wrong!

Sincerely,
Tracy A.

Yes, you will get the paperwork. If you want a preview, just download the pdf version from the patient forms under "contact". it is the minor procedure postop form.

Also, yes, as clarification, don't rip off a scab. just don't let it form in the first place.
best,
sml

[quote="dr. lam"]Yes, you will get the paperwork. If you want a preview, just download the pdf version from the patient forms under "contact". it is the minor procedure postop form.

GREAT, I'LL DO THAT RIGHT AWAY. THANK YOU!

Also, yes, as clarification, don't rip off a scab. just don't let it form in the first place.
best,
sml[/quote]

perfect.

Dear Dr. Lam,

A follow-up question on how to take care of a surgically created wound. As I understand from this thread, after the surgery, one should apply a thick layer of emollient on the incision, and keep it in this moist state most of the time, correct? And this should be maintained until the wound has fully epithelialized?

And if a spot test has been done to prove that the patient is not allergic to antibiotic-impregnated solution, then the antibiotic ointment would be preferred over just a plain ointment to help prevent infection?

Also, should the wound be covered with a gauze with the thick emollient underneath, or be left open? Some say more contact with open air would help the wound recover faster, while others claim that keeping it covered would help prevent the wound from getting dirty (ie. infection).

What is the proper course of action??

leave it open. gauze is not going to help and may not be great. but an emollient is great.
sml

This is all really interesting! Thanks for asking the questions everyone. And thanks to Dr. Lam for schooling us!

you are welcome. see you monday.

Hi Dr. Lam,
It was so nice to finally meet you and your staff yesterday. The whole experience was very pleasant. It is clear that you strive to make the whole experience a positive one for your patients. That is so refreshing!

I'm posting these questions here for the benefit of others.



I've cleaned the 2 areas with stitches with peroxide and applied the Bacitracin (once last night and twice today so far). I've been keeping band aids on the two areas with stitches. I took some tylenol last night because I was a little sore but haven't had any pain today. I'm happy!

Questions:

1) On my lip area, should I be concerned about the bloody area covering the wound? The bloody area covers the entire surface of the wound where the mole was removed and is dark red (dried blood). Basically it looks exactly like it did when I left your office yesterday. I'm assuming this is exactly what it should look like at this point, but just wanted to check. I think you said this area will look more scab-like during the healing process, but I cannot remember for sure. (I asked a lot of questions! )

2) After I shower and wash my face later today, is it ok to apply Lubriderm
lotion to the other areas of my face as long as it doesn't touch the wounds/healing areas?

I can tell I'm going to run out of the sterile swabs you gave me because I'm using at least 8 to 10 with each application of peroxide and ointment. I'm worried about cross-contamination so I won't use the same swab to apply ointment to a different site. Plus, a few were stuck together and I dropped a handful on the floor. Oops!

3) Is it ok to use regular Q-tips when I run out? (Or cotton balls?)

I think that's all for now. Thank you again. I am really excited to finally have these moles gone and also to see what my face looks like after the stitches are out. I have a feeling I'm going to be very, very, happy with the results!

Again, thanks for the wonderful care!
Sincerely,
Tracy

1) On my lip area, should I be concerned about the bloody area covering the wound? The bloody area covers the entire surface of the wound where the mole was removed and is dark red (dried blood). Basically it looks exactly like it did when I left your office yesterday. I'm assuming this is exactly what it should look like at this point, but just wanted to check. I think you said this area will look more scab-like during the healing process, but I cannot remember for sure. (I asked a lot of questions! )
SCABBING IS FINE IN THIS CASE SINCE ALL I DID WAS UNROOF THE MOLE, THEN CAUTERIZE IT. AS DISCUSSED, MY GOAL IS TO PERFORM A SEQUENTIAL MOLE REMOVAL SINCE IT RESTS EXACTLY AT THE PEAK OF THE CUPID'S BOW. TOO DANGEROUS FOR ME TO DO A ONE TIME ON YOU THERE. WE WILL NEED SOME MINOR MODIFICATION AT SOME POINT EITHER WITH SERIAL EXCISION, DERMABRASION, BOTH OR NEITHER.
2) After I shower and wash my face later today, is it ok to apply Lubriderm
lotion to the other areas of my face as long as it doesn't touch the wounds/healing areas?
YES.
I can tell I'm going to run out of the sterile swabs you gave me because I'm using at least 8 to 10 with each application of peroxide and ointment. I'm worried about cross-contamination so I won't use the same swab to apply ointment to a different site. Plus, a few were stuck together and I dropped a handful on the floor. Oops!

3) Is it ok to use regular Q-tips when I run out? (Or cotton balls?)
Yes. and Yes.

Thanks, Dr. Lam!