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Postoperative Nachsorge und Möglichkeiten der Narbenbehandlung in der Lidchirurgie

Postoperative care and options for scar treatment in eyelid surgery

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Zusammenfassung

Okuloplastische Eingriffe stellen aufgrund der funktionellen Bedeutung der Lider für die Oberfläche des Auges spezielle Anforderungen an die postoperative Nachsorge. Wir geben eine Übersicht über die Möglichkeiten, Grenzen und die wissenschaftliche Evidenz zur Nachsorge nach lidchirurgischen Eingriffen hinsichtlich Schwellungsbekämpfung, Schmerzlinderung, Infektionsprophylaxe und Narbenbehandlung.

Abstract

Oculoplastic surgery places special demands on postoperative care because of the functional importance of the eyelids for the ocular surface. We present an overview of postoperative care after surgical eyelid interventions. All options, limits and the scientific evidence are discussed with a special focus on the treatment of postoperative edema, analgesia, infection prophylaxis and scar treatment.

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Literatur

  1. Regan MC, Barbul A (1994) The cellular biology of wound healing. In: Schlag G, Redl H (Hrsg) Wound healing. Springer, New York, Berlin, Heidelberg

    Google Scholar 

  2. Deal DN, Tipton J, Rosencrance E, Curl WW, Smith TL (2002) Ice reduces edema: a study of microvascular permeability in rats. J Bone Joint Surg Am 84-A:1573–1578

    Article  PubMed  Google Scholar 

  3. Schaser KD, Vollmar B, Menger MD, Schewior L, Kroppenstedt SN, Raschke M, Lubbe AS, Haas NP, Mittlmeier T (1999) In vivo analysis of microcirculation following closed soft-tissue injury. J Orthop Res 17:678–685. https://doi.org/10.1002/jor.1100170509

    Article  CAS  PubMed  Google Scholar 

  4. Algafly AA, George KP (2007) The effect of cryotherapy on nerve conduction velocity, pain threshold and pain tolerance. Br J Sports Med 41:365–369. https://doi.org/10.1136/bjsm.2006.031237

    Article  PubMed  PubMed Central  Google Scholar 

  5. Modabber A, Rana M, Ghassemi A et al (2013) Three-dimensional evaluation of postoperative swelling in treatment of zygomatic bone fractures using two different cooling therapy methods: a randomized, observer-blind, prospective study. Trials 14:238. https://doi.org/10.1186/1745-6215-14-238

    Article  PubMed  PubMed Central  Google Scholar 

  6. Pool SM, van Exsel DC, Melenhorst WB, Cromheecke M, van der Lei B (2015) The effect of eyelid cooling on pain, edema, erythema, and hematoma after upper blepharoplasty: a randomized, controlled, observer-blinded evaluation study. Plast Reconstr Surg 135(2):277e–281e

    Article  CAS  PubMed  Google Scholar 

  7. La Piana FG, Irwin AE, Przybyla VA Jr. (1985) Nonsurgical management of postoperative cicatricial lower lid ectropion. Ophthal Plast Reconstr Surg 1(4):283–286

    Article  PubMed  Google Scholar 

  8. Laws DE, Watts MT, Kirkby GR, Lawson J (1989) Is padding necessary after cataract extraction? Br J Ophthalmol 73(9):699–701

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Mayer S, Wirbelauer C, Häberle H, Altmeyer M, Pham DT (2005) Evaluation of eye patching after cataract surgery in topical anesthesia. Klin Monbl Augenheilkd 222(1):41–45

    Article  CAS  PubMed  Google Scholar 

  10. da Silva EMK, Hochman B, Ferreira LM (2014) Perioperative corticosteroids for preventing complications following facial plastic surgery. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD009697.pub2

    Google Scholar 

  11. Gunde MC, Amnerkar ND (2015) Ethnobotanical and pharmacological properties of pineapple protease (Bromelain): a review. Eur J Pharm Med Res 2:126–135

    Google Scholar 

  12. Ernst E, Pittler M (1998) Efficacy of homeopathic arnica: a systematic review of placebo-controlled clinical trials. Arch Surg 133(11):1187–1190

    Article  CAS  PubMed  Google Scholar 

  13. van Exsel DC, Pool SM, van Uchelen JH, Edens MA, van der Lei B, Melenhorst WB (2016) Arnica ointment 10 % does not improve upper blepharoplasty outcome: a randomized, placebo-controlled trial. Plast Reconstr Surg 138(1):66–73

    Article  PubMed  Google Scholar 

  14. Tanaydin V et al (2016) The role of topical vitamin E in scar management: a systematic review. Aesthet Surg J 36(8):959–965

    Article  PubMed  Google Scholar 

  15. Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (2012) Perioperative Antibiotikaprophylaxe. http://www.awmf.org/uploads/tx_szleitlinien/029-022l_S1_Perioperative_Antibiotikaprophylaxe_2012-02.pdf. Zugegriffen: 21.11.17

    Google Scholar 

  16. O’Brien L, Jones DJ (2013) Silicone gel sheeting for preventing and treating hypertrophic and keloid scars. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD003826.pub3

    Google Scholar 

  17. Liu A, Moy RL, Ozog DM (2011) Current methods employed in the prevention and minimization of surgical scars. Dermatol Surg 37(12):1740–1746

    Article  CAS  PubMed  Google Scholar 

  18. Due E, Rossen K, Sorensen LT, Kliem A, Karlsmark T, Haedersdal M (2007) Effect of UV irradiation on cutaneous cicatrices: a randomized, controlled trial with clinical, skin reflectance, histological, immunohistochemical and biochemical evaluations. Acta Derm Venereol 87:27–32

    Article  CAS  PubMed  Google Scholar 

  19. Cho JW, Cho SY, Lee SR, Lee KS (2010) Onion extract and quercetin induce matrix metalloproteinase-1 in vitro and in vivo. Int J Mol Med 25:347–352

    CAS  PubMed  Google Scholar 

  20. Phan TT, Lim IJ, Chan SY, Tan EK, Lee ST, Longaker MT (2004) Suppression of transforming growth factor beta/smad signaling in keloid-derived fibroblasts by quercetin: implications for the treatment of excessive scars. J Trauma 57:1032–1037

    Article  CAS  PubMed  Google Scholar 

  21. Chung VQ, Kelley L, Marra D, Jiang SB (2006) Onion extract gel versus petrolatum emollient on new surgical scars: prospective double-blinded study. Dermatol Surg 32:193–197

    CAS  PubMed  Google Scholar 

  22. Malhotra R et al (2017) Effect of manuka honey on eyelid wound healing: a randomized controlled trial. Ophthal Plast Reconstr Surg 33(4):268–272

    Article  PubMed  Google Scholar 

  23. Anderson MS, Nadkarni A, Cardwell LA, Alinia H, Feldman SR (2017) Spotlight on brimonidine topical gel 0.33 % for facial erythema of rosacea: safety, efficacy, and patient acceptability. Patient Prefer Adherence 6;11:1143–1150

    Article  Google Scholar 

  24. Reinholz M, Heppt M, Tietze JK, Ruzicka T, Gauglitz GG, Schauber J (2015) Photoletter to the editor: topical 0.5 % brimonidine gel to camouflage redness of immature scars. J Dermatol Case Rep 9(3):87–88

    Article  PubMed  PubMed Central  Google Scholar 

  25. Nast A, Eming S, Fluhr J et al (2012) German S2k guidelines for the therapy of pathological scars (hypertrophic scars and keloids). J Dtsch Dermatol Ges 10(10):747–762

    PubMed  Google Scholar 

  26. Heppt MV, Breuninger H, Reinholz M et al (2015) Current strategies in the treatment of scars and keloids. Facial Plast Surg 31(4):386–395

    Article  CAS  PubMed  Google Scholar 

  27. Muneuchi G, Suzuki S, Onodera M, Ito O, Hata Y, Igawa HH (2006) Long-term outcome of intralesional injection of triamcinolone acetonide for the treatment of keloid scars in Asian patients. Scand J Plast Reconstr Surg Hand Surg 40(2):111–116

    Article  PubMed  Google Scholar 

  28. Koc E, Arca E, Surucu B, Kurumlu Z (2008) An open, randomized, controlled, comparative study of the effect of intralesional triamcinolone acetonide and onion extract gel and intralesional triamcinolone acetonide alone in the treatment of hypertrophic scars and keloids. Dermatol Surg 34(11):1507–1514

    CAS  PubMed  Google Scholar 

  29. Mirmanesh M et al (2017) Peri-procedure laser scar therapy protocol: a pilot survey of plastic surgeons’ practices. Aesthetic Plast Surg 41(3):689–694

    Article  PubMed  Google Scholar 

  30. Gassner HG et al (2000) Treatment of facial wounds with botulinum toxin A improves cosmetic outcome in primates. Plast Reconstr Surg 105(6):1948–1953 (discussion 1954–1945)

    Article  CAS  PubMed  Google Scholar 

  31. Gassner HG et al (2006) Botulinum toxin to improve facial wound healing: a prospective, blinded, placebo-controlled study. Mayo Clin Proc 81(8):1023–1028

    Article  CAS  PubMed  Google Scholar 

  32. Zhang DZ et al (2016) Botulinum toxin type A and the prevention of hypertrophic scars on the Maxillofacial area and neck: a meta-analysis of randomized controlled trials. PLOS ONE 11(3):e151627

    Article  PubMed  PubMed Central  Google Scholar 

  33. Caliskan E et al (2016) Intralesional treatments for hypertrophic scars: comparison among corticosteroid, 5‑fluorouracil and botulinum toxin in rabbit ear hypertrophic scar model. Eur Rev Med Pharmacol Sci 20(8):1603–1608

    CAS  PubMed  Google Scholar 

  34. Arno AI et al (2014) Up-to-date approach to manage keloids and hypertrophic scars: a useful guide. Burns 40(7):1255–1266

    Article  PubMed  PubMed Central  Google Scholar 

  35. Nanda S, Reddy BS (2004) Intralesional 5‑fluorouracil as a treatment modality of keloids. Dermatol Surg 30(1):54–56 (discussion 56–57)

    PubMed  Google Scholar 

  36. Asilian A et al (2006) New combination of triamcinolone, 5‑Fluorouracil, and pulsed-dye laser for treatment of keloid and hypertrophic scars. Dermatol Surg 32(7):907–915

    CAS  PubMed  Google Scholar 

  37. Alexandrescu D et al (2016) Comparative results in treatment of keloids with Intralesional 5‑FU/Kenalog, 5‑FU/Verapamil, enalapril alone, verapamil alone, and laser: a case report and review of the literature. J Drugs Dermatol 15(11):1442–1447

    PubMed  Google Scholar 

  38. Occleston NL, O’Kane S, Goldspink N, Ferguson MW (2008) New therapeutic for the prevention and reduction of scarring. Drug Discov Today 13(21–22):973–981

    Article  CAS  PubMed  Google Scholar 

  39. Magnusson BM et al (2006) Percutaneous absorption of steroids: determination of in vitro permeability and tissue reservoir characteristics in human skin layers. Skin Pharmacol Physiol 19(6):336–342

    Article  CAS  PubMed  Google Scholar 

  40. Schaffer MR et al (1997) Nitric oxide, an autocrine regulator of wound fibroblast synthetic function. J Immunol 158(5):2375–2381

    CAS  PubMed  Google Scholar 

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Correspondence to M. Keserü.

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M. Keserü, S. Dulz, A. Wolf, S. Green, U. Press und U. Schaudig geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Keserü, M., Dulz, S., Wolf, A. et al. Postoperative Nachsorge und Möglichkeiten der Narbenbehandlung in der Lidchirurgie. Ophthalmologe 115, 283–292 (2018). https://doi.org/10.1007/s00347-017-0617-5

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  • DOI: https://doi.org/10.1007/s00347-017-0617-5

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