Update in Wound Healing in
Facial Plastic Surgery
Hershcovitch MD, Hom DB. Update in wound healing in facial
plastic surgery. Arch Facial Plast Surg. 2012;14(6):387-393.
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Introduction
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New advances in wound healing relevant to facial plastic surgery are
making an impact on how we approach wounds.
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Purpose: To briefly highlight contemporary wound-healing products and
concepts. New biological and synthetic wound-healing products are now
commercially available. In addition, other potential technologies to improve
wound healing are described in this update.
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Relevance to Clinical Practice: Many of the products and devices
described here are commercially available adjuncts to wound healing. Some
of the products are novel and may be used more in the near future.
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Data Collection and Analysis
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A literature search was done on PubMed with the following terms: “wound
healing,” “otolaryngology,” and “facial plastic surgery.” All searching done
with different permutations.
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Articles were collated with an emphasis on those published since 2008 (the
last Archives update on wound healing).
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Growth-Factor Use in the Head and Neck
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Becaplermin (recombinant human platelet–derived growth factor
[rhPDGF]–BB) used in conjunction with standard wound-care
techniques has been shown to result in only modest increases in
wound healing in chronic wounds.
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Another strategy is to give a growth factor prophylactically to
accelerate a normal wound to heal faster. This novel approach uses
keratinocyte growth factor 2, also called palifermin (Kepivance;
Amgen), a US Food and Drug Administration–approved product, to
proactively reduce the severity of oral mucositis in patients who will be
given chemoradiation for hematologic cancers.
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Growth-Factor Use in the Head and Neck
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Recombinant human transforming growth factor (rhTGF) β3, also called
avotermin (Juvista; Renovo), has shown promise to reduce scarring by
intradermal injection compared with controls in several double-blind,
placebo-controlled clinical trials.
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Platelet-Rich Plasma
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A meta-analysis of platelet-rich plasma (PRP) use in humans concluded
that in chronic wounds, PRP promoted healing. For acute wounds, PRP
appeared to reduce infection.
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It is difficult to compare the multiple published PRP clinical studies because
different methods and definitions were used for measuring the healing
parameters.
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Study Using Autologous Platelet-Rich Gel
in Skin Wounds
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Closure by secondary intention of full-thickness,
4-mm-diameter skin punch wounds in healthy
volunteers over time. A, Control side. B, Side
treated with autologous platelet-rich gel.*
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When the platelet concentration of the PRP was
more than 6 times the baseline intravascular
levels, epithelialization and granulation formation
appeared 3 days earlier in the autologous
platelet-rich gel–treated wounds than in the
control sites.
*Copyright release pending. This image was first published in the
Archives as part of a single-blinded pilot study (Hom DB, Linzie BM,
Huang TC. The healing effects of autologous platelet gel on acute
human skin wounds. Arch Facial Plast Surg. 2007;9[3]:174-183).
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Novel Techniques in Wound Healing
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A case study performed nasal dorsal
augmentation by inserting diced
cartilage wrapped with autologous tissue
glue to the nasal dorsum by an external
nasal (A) and internal nasal
(intercartilaginous incision) (B) approach
(Bullocks JM, Echo A, Guerra G, Stal S,
Yuksel E. A novel autologous scaffold
for diced-cartilage grafts in dorsal
augmentation rhinoplasty. Aesth Plast
Surg. 2011;35[4]:569-579).
Novel Techniques in Wound Healing
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Wegener granulomatosis induced saddle
nose deformity in a woman who
underwent a rhinoplasty and dorsal
augmentation with a diced-cartilage graft
and autologous tissue glue. Preoperative
photographic views (top row) and 10month postoperative views (bottom row)
are shown (Bullocks JM, Echo A, Guerra
G, Stal S, Yuksel E. A novel autologous
scaffold for diced-cartilage grafts in
dorsal augmentation rhinoplasty. Aesth
Plast Surg. 2011;35[4]:569-579).
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More longitudinal studies are needed.
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Novel Techniques in Wound Healing
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Future Directions
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In summary, over the past 10 years, we have seen several strides in
biological, synthetic, and genetic products that expand our armamentarium
to treat facial wounds. Such advancement in the ability to modify the healing
process allows physicians to proactively treat wounds and thus reduce
wound healing complications.
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The concept of prophylactically administering a growth factor before or
during wounding to reduce scarring is a fascinating strategy.
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Discussion
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Although growth factors, bioengineered tissue substitutes, vacuum-assisted
dressing, and hyperbaric oxygen are additional tools to assist in wound
healing, they are not a substitute for the basic tenets of wound care.
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The crucial tenets for encouraging wound healing are to minimize infection,
maximize tissue oxygenation, ensure adequate nutrition, debride tissue
when necessary, and institute proper wound care.
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Conclusions
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It is important for the facial plastic surgeon to be aware of these evolving
concepts on optimizing facial wound healing in the future.
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Contact Information
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If you have questions, please contact the corresponding author:
– David B. Hom, MD, Division of Facial Plastic and Reconstructive
Surgery, Department of Otolaryngology–Head and Neck Surgery,
University of Cincinnati College of Medicine, 231 Albert Sabin Way, PO
Box 670528, Room 6507, Cincinnati, OH 45267
([email protected]).
Funding/Support
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This review was supported by a research grant by the Cincinnati Children’s
Hospital Medical Center.
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