The entire surgical dressing consists of a single layer of flesh-colored dermal tape placed on a solution adhering to mastisol™, which is applied to the skin edges of the incision (Figure 11-27). Drains are completely useless and undesirable in primary augmentation.1-4 Other additives such as special bras or straps, indwelling catheters for injecting local anesthetics, pain pumps, narcotic analgesics and implant movement exercises are also completely useless and undesirable as they unnecessarily complicate and prolong the patient`s recovery. Details of postoperative management according to the principles of 24-hour recovery are given in Chapters 20 and 21. Patients are advised to shower 3-4 hours after returning home, perform exercises to lift their right arms and leave the house for dinner, or shop on the night of surgery with ibuprofen as the only painkiller. With this regimen, 96% of the 627 patients returned to normal (non-aerobic) activities within 24 hours of the increase.1,2 Gauze became the most widely used surgical dressing. It is inexpensive, readily available, highly permeable, highly absorbent and non-occlusive. Gauze comes in woven and non-woven form and can be used as a primary or secondary dressing. Rolled gauze should be applied in such a way as to avoid a tourniquet effect. Packing strips are used to prevent premature closure or to drain exudate. Gauze is used on infected and uninfected wounds, large or irregularly shaped wounds. Wet and dry gauze dressings should be avoided. A wound should retain some moisture so as not to damage healthy tissue when removing a bandage.
Although wet to dry dressings mechanically clean a wound, the removal of the parched gauze can re-injure a wound, causing pain and delaying healing. Gauze residues can also cause granulomas to form.144 In addition, mechanical debridement can cause cross-contamination of wounds by dispersing bacteria into the air after removal and indiscriminately removing adjacent healthy tissue. Gauze is permeable to exogenous bacteria and is associated with a higher rate of infection than transparent films or hydrocolloids.97 Gauze can also cause localized tissue cooling by evaporation, leading to vasoconstriction, hypoxia, and impaired leukocyte and phagocyte activity, which can interfere with wound healing.97 Because gauze dressings usually need to be changed three times a day, This can affect the time and costs of care. However, most of the criticisms about the use of gauze remain theoretical. There are no RCTs that show a statistically significant difference between dressings when the primary endpoint is time to wound healing.144 No, NPWT is not designed to be used with a separate primary dressing. The claimed effectiveness of NPWT is partly related to the direct contact of the NPWT dressing with the wound bed. Code A6550 describes an expense allowance for a dressing kit used in conjunction with a fixed or portable NPWT pump (E2402). A single A6550 code is used for each complete individual dressing change and contains all necessary components, including but not limited to separate non-adhesive porous dressings, drainage pipes and an occlusive dressing that creates a seal around the wound site to maintain subatmospheric pressure on the wound. The surgical dressing is removed at the first postoperative visit. Many surgeons then continue patching full-time until the epithelial layer of the corneal transplant is completely healed. In most cases, it takes 1 to 3 days.2 Although there is a tendency not to patch traumatic corneal abrasions, and at least one study has found that patching does not accelerate healing,1,3 immediate postoperative transplantation is numbing, and the protection of a light but effective pressure patch can be beneficial.
The eye is protected long-term with glasses during the day and a shield at night4 for 2-3 months. In a review of “Treatment of pain at skin graft donor sites,” Sinha and colleagues (2017) found that split-thickness skin grafting is the most common reconstruction procedure in the treatment of burns.