Boston - For the seven to 10 days following CO2 laser resurfacing, efforts are focused on healing the wound that is produced. A new pilot study has demonstrated that significantly less crusting occurs when an oxygen-nutrient spray mist is used, compared to a traditional occlusive dressing, in the critical postoperative period. This protocol may positively impact healing.

"We know that wounds heal more quickly if we don't let them crust over," said Gregg M. Menaker, M.D., one of the study investigators. "Wounds heal 40 percent faster if you don't let them scab over," he added.

It has long been known that oxygen can increase the rate of wound healing, said Dr. Menaker, director, dermatologic surgery unit, Massachusetts General Hospital, Harvard Medical School. "So we wanted to apply that knowledge to laser resurfacing."

Polyurethane foam falls from favor

The study also yielded an unexpected result, Dr. Menaker said. "Going into the study we thought that patients preferred the closed technique with polyurethane foam because they did not have to be bothered splashing their faces with water all the time," he said. Also, with the occlusive technique, patients did not have to worry about whether they were performing the wound care correctly. "We were a little bit surprised because the patients actually preferred the oxygen mist therapy," Dr. Menaker said. Patients indicated that

they felt they were getting better care with the oxygen-nutrient mist, and their worries about whether they were caring for their faces correctly were alleviated because the care was being done for them on a daily basis during the immediate postoperative period. Patients also complained that it was very confining to have the polyurethane bandage in place for several days.

In the study of three patients, one half of each patient's face was resurfaced using a CO2 laser. The 15 minute oxygen mist protocol was applied for the first five days following the resurfacing.

"We sprayed these nutrients on once a day in order to optimize the nutritional status of the skin, so that the wound repair could proceed as quickly as possible," he said. The nutrient mist included several components, including chloride, sodium, potassium, lactate, acetate, glucose, urea, choline, amino acids, and nucleic acid derivatives, all of the building blocks of wound healing.

After the five days, the patients splashed their faces with water and used Vaseline until they were completely healed in about 10 days. Three weeks later, an identical CO2 resurfacing procedure was applied to the other side of the face and a traditional closed dressing of polyurethane foam was applied. On the fourth postoperative day, the patients removed the dressing themselves and began splashing their faces with water every few hours and applying Vaseline after the splashing as they had done after the oxygen mist therapy. They continued until they were completely healed at about 10 days.

Patients were photographed on the fifth day following the surgery, at one month, and again at seven to eight months. The two sides of the face at each time point were compared for several characteristics, including differences in erythema, amount of crusting, scarring, and acne.

Little difference

"The only significant difference between the two sides of the face was the amount of crusting," Dr. Menaker said, "and that was at postoperative day five." The improvement in facial wrinkles and skin quality was the same on both sides he added.

"This is a significant finding," Dr. Menaker said. "We felt that overall, the wound care was optimized using the oxygen mist therapy."

Another benefit to this technique is that keeping the wound open facilitates wound monitoring, and any problems that occur can be detected quickly. There were no side effects from the oxygen or the nutrient mist detected.

This first small pilot study was completed to determine if the patients liked the treatment and to determine if their wounds healed at least as well as the occlusive dressing method, Dr. Menaker said. The next step is to complete larger trials using the oxygen-nutrient mist therapy.

Dr. Menaker completed the study while he was a fellow in MOHs and cosmetic surgery in Los Angeles, Calif.

None of the authors have any financial interest in any of the products used in the study.

FOR MORE INFORMATION

* Onouye T; Menaker G; Christian M; Moy. R. Occlusive dressing vs. oxygen mist therapy following CO2 laser resurfacing. Dermatol Surg, 2000 Jun; 26(6):572-576.

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