Copyright restrictions may apply 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):

Copyright restrictions may apply Introduction New advances in wound healing relevant to facial plastic surgery are making an impact on how we approach wounds. 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. 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.

Copyright restrictions may apply Data Collection and Analysis A literature search was done on PubMed with the following terms: “wound healing,” “otolaryngology,” and “facial plastic surgery.” All searching done with different permutations. Articles were collated with an emphasis on those published since 2008 (the last Archives update on wound healing).

Copyright restrictions may apply Growth-Factor Use in the Head and Neck 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. 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.

Copyright restrictions may apply Growth-Factor Use in the Head and Neck 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.

Copyright restrictions may apply Platelet-Rich Plasma 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. It is difficult to compare the multiple published PRP clinical studies because different methods and definitions were used for measuring the healing parameters.

Copyright restrictions may apply Study Using Autologous Platelet-Rich Gel in Skin Wounds 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.* 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]: ).

Copyright restrictions may apply Novel Techniques in Wound Healing 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]: ).

Copyright restrictions may apply Novel Techniques in Wound Healing 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 10- month 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]: ). More longitudinal studies are needed.

Copyright restrictions may apply Novel Techniques in Wound Healing

Copyright restrictions may apply Future Directions 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. The concept of prophylactically administering a growth factor before or during wounding to reduce scarring is a fascinating strategy.

Copyright restrictions may apply Discussion 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. 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.

Copyright restrictions may apply Conclusions It is important for the facial plastic surgeon to be aware of these evolving concepts on optimizing facial wound healing in the future.

Copyright restrictions may apply Contact Information 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 , Room 6507, Cincinnati, OH Funding/Support This review was supported by a research grant by the Cincinnati Children’s Hospital Medical Center.