Coriene E. Hannape | Contributing Editor

Boston - Healing the wound produced following CO2 laser resurfacing, and lasts for seven to 10 days after the procedure, is a main concern for many physicians.

A pilot study 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."
Oxygen can increase the rate of wound healing, said Dr. Menaker, who is director of the dermatologic surgery unit at Massachusetts General Hospital, Harvard Medical School. "So we wanted to apply that knowledge to laser resurfacing."

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.

A feeling of better care:

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."

Patients indicated that they felt they were getting better care with the oxygen-nutrient mist. In this study of three patients, one half of each patients face was resurfaced using a CO2 laser. The 15-minute oxygen mist protocol was applied for the first five days following the laser 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," Dr. Menaker said. The nutrient mist included several components, including chloride, sodium, potassium, lactate, acetate, glucose, urea, choline, amino acids, and nucleic acid derivatives. 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 laser 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 erythema, amount of crusting, scarring, and acne.

"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.

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, CST