The effect of Hypericum perforatum on the wound healing and scar of cesarean. Early intervention with non‐ablative fractional laser to improve cutaneous scarring—A randomized controlled trial on the impact of intervention time and fluence levels Improving Scar Quality: A Prospective Clinical Study [Clinical observation of the long-term effects of rhEGF on deep partial-thickness burn wounds]. Can Medical Hypnosis Accelerate Post-Surgical Wound Healing? Results of a Clinical Trial Preoperative anxiety in ambulatory surgery: The impact of an empathic patient-centered approach on psychological and clinical outcomes. Comparison of two power densities on the healing of palatal wounds after connective tissue graft removal: randomized clinical trial Hyaluronic acid impedes reepithelialization of skin graft donor sites. Nitrous oxide and risk of surgical wound infection: a randomised trial Wound drains in proximal femoral fracture surgery: a randomized prospective trial of 177 patients. Topical Application of Aloe vera Accelerated Wound Healing, Modeling, and Remodeling: An Experimental Study Tissue adhesive vs sutures in closure of incision wounds. A comparative study in human skin. The effects of different nutritional measurements on delayed wound healing after hip fracture in the elderly. Comparative study of skin wound closure with polybutester (Novafil) and polypropylene. Management of chronic pressure ulcers: an evidence-based analysis.
OBJECTIVE The aim of this study was to determine the effects of Hypericum perforatum on  cesarean wound healing and hypertrophic scar .  DESIGN This was a r and omized , double-blind clinical trial study . SETTING The study was conducted in Samen-Ol-Aemmeh ( Pbuh ) Hospital in Mashhad , Iran . SUBJECTS The subjects included 144 women with surgical childbirth who had eligible criteria . INTERVENTION The participants were r and omly assigned to three groups . The treatment and placebo groups applied H. perforatum or placebo ointment 3 times a day for 16 days based on consecutive coded ointments . The control group remained without any intervention postoperatively . ASSESSMENT Wound healing was assessed on the 10th day postcesarean using the REEDA scale ( REEDA st and s for redness , edema , ecchymosis , discharge , and approximation ) , which had criteria including redness , edema , ecchymosis , discharge , and approximation . On the 40th day , the degree of scarring was assessed using the Vancouver scar scale including pigmentation , height , pliability , and vascularity . The subjects were also asked some questions about pain by using the Visual Analogue Scale and pruritus of scar . RESULTS The mean age of all the study subjects was 23.50 + /- 4.03 and mean parity was 1.23 + /- 0.48 . There were significant differences in wound healing on the 10th day ( p < 0.005 ) and scar formation on the 40th day postpartum ( p < 0.0001 ) between treatment group with placebo and control groups . However , the placebo group had no differences in wound healing ( p = 0.93 ) and scar formation ( p = 0.11 ) with the control group . In addition , significantly lower pain and pruritus were reported by the treatment group compared with the placebo and control groups on the 40th day postpartum . CONCLUSIONS Topical application of H. perforatum is safe and can facilitate cesarean wound healing and minimize formation of scar and its pain and pruritus BACKGROUND AND OBJECTIVES Laser treatment in the early phases of wound healing may reduce scar formation . However , little is known on when in the early wound healing phases laser exposure most optimally should be provided and at which fluence levels . This study investigates the clinical effect of non-ablative-fractional-laser ( NAFL ) performed at three early time points at a range of fluence levels versus untreated control scars . MATERIAL S AND METHODS A r and omized , controlled , intra-individual trial with erbium-glass 1,540 nm NAFL versus no laser treatment on sixteen subjects receiving 10 st and ardized full-thickness punch-biopsy wounds . A single NAFL-exposure was applied to test-wounds 1 day before , immediately after , or 2 weeks after wounding . Three fluence levels provided deep and superficial energy depositions ( range 30 - 70 mJ/microbeam ) . Primary outcome comprised the total-score of the observer part of Patient-Observer-Scar- Assessment -Scale ( POSAS ) , performed by blinded on-site assessment at 3 months follow-up . Secondary outcomes were clinical evaluation on visual-analogue-scale ( VAS ) , reflectance measurements , and histology .  RESULTS NAFL-treatment applied 1 day before , immediately after or 2 weeks after wounding had the potential to offer subtle but detectable improvement in clinical scar appearance compared to untreated controls . Thus , NAFL-exposure 1 day before wounding ( POSAS-total : median of 15 vs. control-median of 16 , P = 0.03 , VAS : median 4.1 vs. control-median 5.5 , P = 0.03 , medium-fluence ) , as well as immediately- , and 2 weeks after wounding ( POSAS-total : P ≤ 0.05 , low-fluence ) induced improvement compared to untreated controls . No significant differences in dyschromia were detected between NAFL-treated and control scars . Histology showed subtle changes towards more mature interwoven bundles of collagen in NAFL-treated scars as compared to controls . CONCLUSIONS This study indicates that a single NAFL-treatment at low to medium fluence performed 1 day prior , or in the early phases of wound healing , may have the potential to optimize scar formation in full thickness wounds . Lasers Surg . Med . 50:28 - 36 , 2018 . © 2017 Wiley Periodicals , Following traumatic or surgical injury to the skin , wounds do not heal by tissue regeneration but rather by scar formation . Though healing is definitely a welcomed event , the result ant scar , very often , is not aesthetically pleasing , and not infrequently , may be pathologic causing serious deformities and contractures . Management of problematic scars continues to be a frustrating endeavor with less than optimal results . Prophylactic methods of wound management to minimize serious scarring are being developed . In a previously published study , we have demonstrated improved healing of split thickness skin graft donor sites following treatment with Moist Exposed Burn Ointment ( MEBO , Julphar Gulf Pharmaceutical Industries , Ras Al-Kh aim ah , UAE ) . At present , we are reporting the results of a comparative clinical prospect i ve study evaluating scar quality following primary healing of elective surgical and traumatic facial wounds with prophylactic MEBO application , topical antibiotic ointment application , and no topical therapy at all . Scars were evaluated according to the Visual Analogue Scale for scar assessment . Statistical analysis of scar assessment scores demonstrated marked prevention of unfavorable scars with improved cosmetic results following MEBO prophylactic therapy OBJECTIVE To evaluate the safety and long-term effect of recombinant human epithelial growth factor ( rhEGF ) on deep partial-thickness burn wounds . METHODS Thirty-seven burn patients were enrolled in this study and were observed by r and omized , double-blinded and placebo-controlled protocol . An area of deep partial-thickness burn wounds from each patient was divided into control ( C ) and treatment ( T ) portions . The wound in C was treated with normal saline while that in T with rhEGF . The patients were followed-up for 1 and 4 years after wound healing . The healed wounds were evaluated by modified Vancouver scar scale in terms of scar index ( SI ) . RESULTS 1 year after wound healing , it was found that the SI in T group ( 7.19 + /- 1.67 ) was obviously lower than that in C group ( 8.92 + /- 1.78 , P < 0.01 ) . The SI in T group ( 6.12 + /- 1.54 ) was still evidently lower than that in C group ( 8.09 + /- 1.81 , P < 0.01 ) four years after wound healing . There were no signs of development of tumor or cancer in all the tested burn wound areas . CONCLUSION External application of rhEGF might be beneficial to the healing quality of deep partial-thickness burn wound with less scar formation and better long-term effects , and it is safe Abstract Although medical hypnosis has a long history of myriad functional applications ( pain reduction , procedural preparation etc . ) , it has been little tested for site-specific effects on physical healing per se . In this r and omized controlled trial , we compared the relative efficacy of an adjunctive hypnotic intervention , supportive attention , and usual care only on early post-surgical wound healing . Eighteen healthy women presenting consecutively for medically recommended reduction mammaplasty at an ambulatory surgery practice underwent the same surgical protocol and postoperative care  following preoperative r and omization ( n = 6 each ) to one of the three treatment conditions : usual care , 8 adjunctive supportive attention sessions , or 8 adjunctive hypnosis sessions targeting accelerated wound healing . The primary outcome data of interest were objective , observational measures of incision healing made at 1,7 weeks postoperatively by medical staff blind to the participants ' group assignments . Data included clinical exams and digitized photographs that were scored using a wound assessment inventory ( WAI ) . Secondary outcome measures included the participants ' subjectively rated pain , perceived incision healing ( VAS Scales ) , and baseline and post-surgical functional health status ( SF-36 ) . Analysis of variance showed the hypnosis group 's objective ly observed wound healing to be significantly greater than the other two groups ' , p < .001 , through 7 postoperative weeks ; st and ard care controls showed the smallest degree of healing . In addition , at both the 1 and 7 week post-surgical observation intervals , one-way analyses showed the hypnosis group to be significantly more healed than the usual care controls , p < 0 . 02 . The mean scores of the subjective assessment s of postoperative pain , incision healing and functional recovery trended similarly . Results of this preliminary trial indicate that use of a targeted hypnotic intervention can accelerate postoperative wound healing and suggest that further tests of using hypnosis to augment physical healing are warranted OBJECTIVE This study aims to evaluate the influence of an empathic patient-centered approach on preoperative anxiety and surgical outcomes in ambulatory surgery patients . METHODS A sample of 104 patients undergoing general ambulatory surgery was r and omly assigned to the intervention ( IG ) and the control ( CG ) groups . Before surgery , the IG received personalized information through an empathic patient-centered interview . The CG received st and ardized information on surgical procedures .  Anxiety was assessed before and after the preoperative interview and after the surgery . Wound healing , post-surgical recovery and satisfaction with the quality of preoperative information were assessed after the surgery . RESULTS The two groups were identical at baseline regarding anxiety , socio-demographic and clinical characteristics . After the patient-centered intervention , the IG showed lower levels of preoperative anxiety ( p<0.001 ) and pain ( p<0.001 ) , better surgery recovery ( p<0.01 ) and higher levels of daily activity ( p<0.001 ) and of satisfaction with the information received ( p<0.01 ) than the CG . The IG also showed better wound healing ( tissue type , p<0.01 ; local pain , p<0.01 ) . CONCLUSION An empathic patient-centered intervention can reduce preoperative anxiety and increase surgical recovery , wound healing and patient satisfaction . PRACTICE IMPLICATION S This approach is applicable in pre-surgical interviews and can potentially be used in the routine care of various surgical context Connective tissue graft ( CTG ) , which is considered to be among the best techniques for treating gingival recession , has presented stable long-term results . However , this technique causes morbidity and discomfort in the palatine region due to graft removal at that site . A previous study reports that photobiomodulation ( PBM ) using a dosage of 15 J/cm2 may improve wound healing and the patient ’s postoperative comfort . However , no other studies in the literature provide the best application dosage or comparisons between protocol s for this purpose . The aim of this study is to compare two power densities of PBM on the wound-healing process of the donor palatine area after CTG removal . In this study , 51 patients presenting buccal gingival recession were r and omized into one of the following groups : group 1 : CTG procedure for root coverage and PBM application at the donor site using a 60 J/cm2 dose ; group 2 : CTG and PBM application using a 30 J/cm2 dose ; or group 3 : CTG and sham application . The evaluated parameters were the wound remaining area ( WRA ) , scar and tissue colorimetry ( TC ) , tissue thickness ( TT ) , and postoperative discomfort ( D ) , evaluated at baseline and 7 , 14 , 45 , 60 , and 90 days after surgery . Group 1 presented statistically significant smaller wounds at day 7 ( p > 0.05 ) . None of the patients presented scars at the operated area , and all of the patients reported mild discomfort , with low consumption of analgesic pills . We concluded that the protocol of 60 J/cm2 provided faster wound healing 7 days after removing the connective tissue graft for root coverage . Trial registration : Clinical Trial.org ( NCT02580357 ) https:// clinical trials.gov/ct2/show/NCT02580357 Prior studies have suggested that hyaluronic acid ( HA ) , a naturally occurring glycosaminoglycan , may accelerate the healing of superficial burn wounds . To objective ly assess whether exogenous HA could accelerate the rate of healing and limit scar formation in superficial wounds , 11 patients with burn injuries who were undergoing skin grafting were given two separate skin graft donor sites of similar size and depth ( 1 " x 1 " x 0.016 " ) . In a r and omized , double-blind fashion , one of these partial-thickness wounds had repeated application with 1.5 % HA ; 100 % glycerin , which served as a control of similar viscosity , was applied to the other wound . On alternating days , photographs were taken and then analyzed with computerized digital planimetry to objective ly quantitate the rate of reepithelialization . In contrary to our hypothesis , HA significantly delayed wound healing compared to the glycerin control ( time to > 95 % reepithelialization : 10.3 + /- 2 days HA vs. 9.1 + /- 1.6 days control ; mean + /- SD ) . Furthermore , no difference in the result ant scar at 6 weeks and at 3 months after wounding was evident . These results demonstrate that HA retards healing of partial thickness wounds in adults BACKGROUND Nitrous oxide inactivates vitamin B12 and methionine synthase , thereby impairing DNA formation and , consequently , new cell formation . The gas also inhibits methionine production , which can reduce scar formation and depresses chemotactic migration by monocytes . Therefore , we assessed whether nitrous oxide increases the incidence of surgical wound infection . METHODS We recruited 418 patients aged 18 - 80 years , scheduled for colon resection that was expected to last more than 2 h , at three hospitals in Austria and Hungary . Patients were r and omly assigned 65 % intraoperative nitrous oxide ( n=208 ) or nitrogen ( n=206 ) , with remifentanil and isoflurane . The primary outcome was the incidence of clinical postoperative wound infection , analysed by intention to treat . FINDINGS 206 patients in the nitrous oxide group and 202 in the nitrogen group were included in the final analysis . Duration of surgery was longer in the nitrogen group ( 3.4 h [ 1.5 ] ) than in the nitrous oxide group ( 3.0 h [ SD 1.3 ] ) and arterial pressure ( 84 mm Hg [ 10 ] vs 81 mm Hg [ 9 ] ) , bispectral index values ( 53 [ 9 ] vs 44 [ 8 ] ) , and end-tidal isoflurane concentration ( 0.64 % [ 0.14 ] vs 0.56 % [ 0.13 ] ) were greater in patients given nitrogen than in those given nitrous oxide .  Infection rate was 15 % ( 31/206 ) in patients given nitrous oxide and 20 % ( 40/202 ) in those given nitrogen ( p=0.205 ) . Additionally , the ASEPSIS wound healing score , wound collagen deposition , number of patients admitted to critical care unit , time to first food ingestion , duration of hospital stay , and mortality did not differ between treatment groups . INTERPRETATION Nitrous oxide does not increase the incidence of surgical wound infection We report on a prospect i ve r and omized trial on the effect of wound drains on wound healing following surgery for proximal femoral fractures . One hundred and seventy-seven consecutive patients admitted to Queen 's Medical Centre Nottingham , undergoing AO dynamic hip screw ( DHS ) or hemiarthroplasty were r and omized whether or not to receive  wound drainage .  Wound healing was assessed in terms of ultrasound examination , the ASEPSIS wound score system and overt infection rates . All patients were followed up at 6 weeks and 6 months . Ultrasound examinations showed that drains were indeed ineffective in preventing haematoma formation , the first time this has been demonstrated objective ly . However , using drains failed to prevent late seroma formation . Patients who received wound drainage showed statistically better wound healing on the ASEPSIS wound scoring system and a reduced infection rate . The ASEPSIS scores on day 2 and 5 postoperatively proved an accurate predictor of poor wound healing . This study conflicts with previous smaller studies which failed to show an effect of wound drainage upon wound healing , and strongly supports the use of wound drains Objective Treatment of large wounds is technically dem and ing and several attempts have been taken to improve wound healing . Aloe vera has been shown to have some beneficial roles on wound healing but its mechanism on various stages of the healing process is not clear . This study was design ed to investigate the effect of topical application of A. vera on cutaneous wound healing in rats . Methods A rectangular 2 × 2-cm cutaneous wound was created in the dorsum back of rats . The animals were r and omly divided into 3 groups of control ( n = 20 ) , low-dose ( n = 20 ) , and high-dose ( n = 20 ) A. vera . The control and treated animals were treated daily with topical application of saline , low-dose ( 25 mg/mL ) , and high-dose ( 50 mg/mL ) A. vera gel , up to 10 days , respectively . The wound surface , wound contraction , and epithelialization were monitored . In each group , the animals were euthanized at 10 ( n = 5 ) , 20 ( n = 5 ) , and 30 ( n = 10 ) days post injury ( DPI ) . At 10 , 20 , and 30 DPI , the skin sample s were used for histopathological and biochemical investigations ; and at 30 DPI , the skin sample s were also subjected for biomechanical studies . Results Aloe vera modulated the inflammation , increased wound contraction and epithelialization , decreased scar tissue size , and increased alignment and organization of the regenerated scar tissue . A dose-dependent increase in the tissue level of dry matter , collagen , and glycosaminoglycans ’ content was seen in the treated lesions , compared to the controls . The treated lesions also demonstrated greater maximum load , ultimate strength , and modulus of elasticity compared to the control ones ( P < 0.05 ) . Conclusions Topical application of A. vera improved the biochemical , morphological , and biomechanical characteristics of the healing cutaneous wounds in rats . This treatment option may be valuable in clinical practice Two  different st and ard incisions  were used to compare the healing of wounds closed with normal " atraumatic " surgical technique and with a tissue adhesive .  Healing was recorded by serial photography . It was found that wounds , which were not under tension postoperatively , the result ing scar was cosmetically better when tissue adhesive was used compared with conventional methods of suture BACKGROUND It has been well recognized that malnutrition causes wounds to heal inadequately and incompletely . Malnutrition is often observed in the elderly , and it appears to be more severe in patients with hip fracture than in the general aging population . Few prospect i ve studies give a detailed account of the identification and classification of nutritional status in the elderly . The objective of this study was to evaluate the effects of different nutritional measurements on wound healing status after hip fracture in the elderly . METHODS From September 2002 to December 2007 , 207 hip fracture patients older than 60 y treated surgically were review ed for preoperative nutritional status . There were 81 males and 126 females with an average age of 75.93 y ( 62 - 91 y ) ; 131 cases with femoral neck fractures , 76 cases with intertrochanteric fractures . Parameters indicative of nutritional status ( serum albumin , serum transferrin , serum pre-albumin , and total lymphocyte count levels ) at the time of admission were assessed , along with  anthropometric measurements , Rainey MacDonald nutritional index , and MNA tool . Suture removal was performed on postoperative day 14 . RESULTS Delayed wound healing complicated 46 ( 22.2 % ) of the 207 cases . The preoperative serum transferring total lymphocyte count levels , MNA total score , and Rainey MacDonald nutritional index were significantly lower for patients who subsequently had delayed wound healing . When all variables were subjected to multivariate analysis , only total lymphocyte count levels and MNA total score showed significant value in predicting which patients would have delayed wound healing . Through prophylactic antibiotics and adherence to strict aseptic pre caution s , on follow-up , wound healing was normal in all patients . CONCLUSIONS Patients at risk for delayed wound healing problems  after hip fracture can be identified using relatively inexpensive laboratory test such as TLC and MNA tool . The clinician must be aware of the risk values of both measurements . We believe this information is particularly important before planning procedures of hip fractures in the elderly A prospect i ve study of skin wound closure using polybutester ( Novafil ) and polypropylene was carried out in 100 elective procedures in 77 patients over a 1-year period at the Plastic Surgery Unit of Mubarak Al Kabeer Hospital , Kuwait . In this comparative study based on clinical evaluation , particular note was made of the h and ling characteristics of the suture material , wound infection , healing and eventual scar in each case . The tensile strength of both sutures was comparable and the wound infection rate and wound healing characteristics in the two groups were more or less the same . Our study has shown Novafil to be a superior suture for skin wound closure because of its h and ling qualities , easier removal from the healed wound and because of a cosmetically better scar in a significant number of patients UNLABELLED In April 2008 , the Medical Advisory Secretariat began an evidence -based review of the literature concerning pressure ulcers . Please visit the Medical Advisory Secretariat Web site , http://www.health.gov.on.ca/english/providers/program/mas/tech/tech_mn.html to review these titles that are currently available within the Pressure Ulcers series . PRESSURE ULCER PREVENTION : an evidence based analysis The cost-effectiveness of prevention strategies for pressure ulcers in long-term care homes in Ontario : projections of the Ontario Pressure Ulcer Model ( field evaluation)MANAGEMENT OF CHRONIC PRESSURE ULCERS : an evidence -based analysis OBJECTIVE The Medical Advisory Secretariat ( MAS ) conducted a systematic review on interventions used to treat pressure ulcers in order to answer the following questions : Do currently available interventions for the treatment of pressure ulcers increase the healing rate of pressure ulcers compared with st and ard care , a placebo , or other similar interventions ? Within each category of intervention , which one is most effective in promoting the healing of existing pressure ulcers ? BACKGROUND A pressure ulcer is a localized injury to the skin and /or underlying tissue usually over a bony prominence , as a result of pressure , or pressure in conjunction with shear and /or friction . Many areas of the body , especially the sacrum and the heel , are prone to the development of pressure ulcers . People with impaired mobility ( e.g. , stroke or spinal cord injury patients ) are most vulnerable to pressure ulcers . Other factors that predispose people to pressure ulcer formation are poor nutrition , poor sensation , urinary and fecal incontinence , and poor overall physical and mental health . The prevalence of  pressure ulcers  in Ontario has been estimated to range from a median of 22.1 % in community setting s to a median of 29.9 % in nonacute care facilities . Pressure ulcers have been shown to increase the risk of mortality among geriatric patients by as much as 400 % , to increase the frequency and duration of hospitalization , and to decrease the quality of life of affected patients . The cost of treating pressure ulcers has been estimated at approximately $ 9,000 ( Cdn ) per patient per month in the community setting . Considering the high prevalence of pressure ulcers in the Ontario health care system , the total cost of treating pressure ulcers is substantial . TECHNOLOGY Wounds normally heal in 3 phases ( inflammatory phase , a proliferative phase of new tissue and matrix formation , and a remodelling phase ) . However , pressure ulcers often fail to progress past the inflammatory stage . Current practice for treating pressure ulcers includes treating the underlying causes , debridement to remove necrotic tissues and contaminated tissues , dressings to provide a moist wound environment and to manage exu date s , devices and frequent turning of patients to provide pressure relief , topical applications of biologic agents , and nutritional support to correct nutritional deficiencies . A variety of adjunctive physical therapies are also in use . METHOD Health technology assessment data bases and medical data bases were search ed from 1996 ( Medline ) , 1980 ( EMBASE ) , and 1982 ( CINAHL ) systematic ally up to March 2008 to identify r and omized controlled trials ( RCTs ) on the following treatments of pressure ulcers :  cleansing , debridement , dressings , biological therapies , pressure-relieving devices , physical therapies , nutritional therapies , and multidisciplinary wound care teams . Full literature search strategies are reported in appendix 1 . English- language studies in previous systematic review s and studies published since the last systematic review were included if they had more than 10 subjects , were r and omized , and provided objective outcome measures on the healing of pressure ulcers . In the absence of RCTs , studies of the highest level of evidence available were included . Studies on wounds other than pressure ulcers and on surgical treatment of pressure ulcers were excluded . A total of 18 systematic review s , 104 RCTs , and 4 observational studies were included in this review . Data were extracted from studies using st and ardized forms . The quality of individual studies was assessed based on adequacy of r and omization , concealment of treatment allocation , comparability of groups , blinded assessment , and intention-to-treat analysis . Meta- analysis to estimate the relative risk ( RR ) or weighted mean difference ( WMD ) for measures of healing was performed when appropriate . A descriptive synthesis was provided where pooled analysis was not appropriate or not feasible . The quality of the overall evidence on each intervention was assessed using the grading of recommendations assessment , development , and evaluation ( GRADE ) criteria . FINDINGS Findings from the analysis of the included studies are summarized below : CLEANSING : There is no good trial evidence to support the use of any particular wound cleansing solution or technique for pressure ulcers . DEBRIDEMENT : There was no evidence that debridement using collagenase , dextranomer , cadexomer iodine , or maggots significantly improved complete healing compared with placebo . There were no statistically significant differences between enzymatic or mechanical debridement agents with the following exceptions : Papain urea result ed in better debridement than collagenase . Calcium alginate result ed in a greater reduction in ulcer size compared to dextranomer . Adding streptokinase/streptodornase to hydrogel result ed in faster debridement . Maggot debridement result ed in more complete debridement than conventional treatment . There is limited evidence on the healing effects of debridement devices . DRESSINGS : Hydrocolloid dressing was associated with almost three-times more complete healing compared with saline gauze . There is evidence that hydrogel and hydropolymer may be associated with 50 % to 70 % more complete healing of pressure ulcers than hydrocolloid dressing . No statistically significant differences in complete healing were detected among other modern dressings . There is evidence that polyurethane foam dressings and hydrocellular dressings are more absorbent and easier to remove than hydrocolloid dressings in ulcers with moderate to high exu date s . In deeper ulcers ( stage III and IV ) , the use of alginate with hydrocolloid result ed in significantly greater reduction in the size of the ulcers compared to hydrocolloid alone . Studies on sustained silver-releasing dressing demonstrated a tendency for reducing the risk of infection and promoting faster healing , but the sample sizes were too small for statistical analysis or for drawing conclusions . BIOLOGICAL THERAPIES : The efficacy of platelet-derived growth factors ( PDGFs ) , fibroblast growth factor , and granulocyte-macrophage colony stimulating factor in improving complete healing of chronic pressure ulcers has not been established . Presently only Regranex , a recombinant PDGF , has been approved by Health Canada and only for treatment of diabetic ulcers in the lower extremities . A March 2008 US Food and Drug Administration ( FDA ) communication reported increased deaths from cancers in people given three or more prescriptions for Regranex . Limited low- quality evidence on skin matrix and engineered skin equivalent suggests a potential role for these products in healing refractory  advanced chronic pressure ulcers , but the evidence is insufficient to draw a conclusion . ADJUNCTIVE PHYSICAL THERAPY : There is evidence that electrical stimulation may result in a significantly greater reduction in the surface area and more complete healing of stage II to IV ulcers compared with sham therapy . No conclusion on the efficacy of electrotherapy can be drawn because of significant statistical heterogeneity , small sample sizes , and method ological flaws . The efficacy of other adjunctive physical therapies [ electromagnetic therapy , low-level laser ( LLL ) therapy , ultrasound therapy , ultraviolet light therapy , and negative pressure therapy ] in improving complete closure of pressure ulcers has not been established . NUTRITION THERAPY : Supplementation with 15 grams of hydrolyzed protein 3 times daily did not affect complete healing but result ed in a 2-fold improvement in Pressure Ulcer Scale for Healing ( PUSH ) score compared with placebo . Supplementation with 200 mg of zinc three times per day did not have any significant impact on the healing of pressure ulcers compared with a placebo . Supplementation of 500 mg ascorbic acid twice daily was associated with a significantly greater decrease in the size of the ulcer compared with a placebo but did not have any significant impact on healing when compared with supplementation of 10 mg ascorbic acid three times daily . A very high protein tube feeding ( 25 % of energy as protein ) result ed in a greater reduction in ulcer area in institutionalized tube-fed patients compared with a high protein tube feeding ( 16 % of energy as protein).Multinutrient supplements that contain zinc , arginine , and vitamin C were associated with a greater reduction in the area of the ulcers compared with st and ard hospital diet or to a st and ard supplement without zinc , arginine , or vitamin C.Firm conclusions can not be drawn because of method ological flaws and small sample sizes . MULTIDISCIPLINARY WOUND CARE TEAMS : The only RCT suggests that multidisciplinary wound care teams may significantly improve healing in the acute care setting in 8 weeks and may significantly shorten the length of hospitalization . However , since only an abstract is available , study biases can not be assessed and no conclusions can be drawn on the quality of this evidence
Conclusions This systemic review shows that preoperative interventions can be beneficial in improving wound healing and scar formation .
In selected cases , wound healing was found to benefit from a higher preoperative body temperature , topical vitamin E application , and low patient stress levels .
Background Poor wound healing and scar formation  remain critical problems in daily surgical practice .
Generally , most attention is paid to intra- and postoperative interventions to improve wound healing after surgery , while preoperative interventions remain unsatisfactorily explored .
Objectives In this systematic review , the available literature on the beneficial effects of preoperative interventions on wound healing and scar formation have been summarized and compared .