POD #23

So this could be my last week of "Vacation"... my walking is pretty normalized, my biggest concern at this point is taking any (figurative) steps backwards (I am all for taking actual backwards steps). Since working as a PT means being on your feet most of the day, swelling is my enemy. Should be interesting how that plays out when I am back full-time.

This weekend I indulged a little more than I probably should have. Friday night was my high school football dinner. As a coach I felt slightly obligated to make an appearance. Of course we always have a good time. And this was the weekend I sent back my Gameready, I would buy one if I had an extra $2,350.00 laying around! The combination of sub par icing along with increased mobility led to a slight increase in swelling, boo!

Another interesting aspect to this operation is the scar. Scar tissue is a natural and necessary part of healing, but you also do not want too much... a fine balance must be matched. So I was looking into products for treating the scar, chicks dont necessarily dig scars on the knees...
mederma keeps popping up as a recommended treatment, so I decided to investigate further; three articles came up in pubmed regarding this cream:

1. Petrolatum-based topical agents constitute standard therapy in the management of postoperative wounds. In this side-by-side, randomized, double-blinded, split-scar study, the onion extract gel [mederma] did not improve scar cosmesis or symptomatology when compared with a petrolatum-based ointment.
2. Despite the authors' inability to demonstrate a reduction in scar hypertrophy, the improvement in collagen organization noted in the Mederma-treated scars suggests it may have an effect on the pathophysiology of hypertrophic scar formation.
3. Snake oil for the 21st century.

This is another interesting study I no longer have access to (my university cut my access since its been 6 months after graduation - gonna have to have a talking with them).

Vitamin E was another highly touted remedy for scars but here are a few interesting articles regarding that issue:
QUESTION: A few of my patients have been told to use vitamin E cream after surgery or repair of a laceration. What is the evidence for this suggestion, and is this treatment suitable for all patients? ANSWER: Vitamin E is the main lipid-soluble antioxidant in the skin. Several anecdotal reports have suggested that topical use of vitamin E cream can reduce scar formation. Current evidence from the literature, however, does not support that proposition. In fact, studies report some adverse effects with use of vitamin E. Further research is needed before application of vitamin E cream becomes the standard of care.

-Without scientific basis, health professionals continue to recommend vitamin E for use on scars. Such recommendations should not be made in the absence of evidence-based medicine.

This study shows that there is no benefit to the cosmetic outcome of scars by applying vitamin E after skin surgery and that the application of topical vitamin E may actually be detrimental to the cosmetic appearance of a scar. In 90% of the cases in this study, topical vitamin E either had no effect on, or actually worsened, the cosmetic appearance of scars. Of the patients studied, 33% developed a contact dermatitis to the vitamin E. Therefore we conclude that use of topical vitamin E on surgical wounds should be discouraged.

Scar-free healing with gene suppression

New mechanical insights into wound healing and scar tissue formation

How'd you get that scar?

That's all for now... I am going to the pharmacy tomorrow to make up my mind on scar ointments... the evidence hasn't helped me much and the stories I have heard from colleagues and friends have been mixed... anyone want to share their experiences?