Interview with Dr. Vipul R. Dev: Post-Surgical Wound Care
Interview with Dr. Vipul R. Dev, M.D.
Q: Please describe your background and experience when it comes to skincare and healing.
A: By training, I am a plastic surgeon. Before that, I was a general surgeon and trauma surgeon. My connection with wounds and healing is this: all surgeons create wounds for a living. Whether it becomes a problem, or we make a clean cut and the patient heals from an elective surgery, it’s still a wound. So I see it as that’s our business - from the minute we meet the patient and go through with the operation, to the minute we discharge them once they’ve healed. As a plastic surgeon, I take that a little further: it’s important for a plastic surgeon to maintain the integrity of the post-surgical wound and the skin integrity and you can’t do that without the proper tools which are preventive and maintenance (maintenance meaning maintaining healthy and hydrated skin with or without a wound). In other words, the skin is the canvas I’m working with and the healthier the skin, the better the healing.
Q: What should I consider when caring for a post-surgical wound?
A: One should consider the following:
- The post-surgical wound should be healthy and hydrated. Think about soil - dry, parched soil does not cultivate well. That’s how I consider skin. It’s important to have a moist healthy surface of skin that has integrity (good structure, good form, moist and supple).
- The wound should be free of bacteria and contamination.
- The post-surgical wound should have the right architecture with the “right scaffolding” or structure and foundation to nurture new cellular growth. The healthier the cells are that grow into the scaffolding, the healthier the skin.
Q: How does diet play a role?
A: Diet plays a big role and so does sun exposure. Also, what you do to protect your skin from sun exposure and other environmental factors is important.
Q: How do I prevent infection?
A: The best way to prevent infection is to make sure you have all three of those things that I mentioned earlier: make sure that the skin is adequately hydrated, make sure that it’s contamination free, and that you have good skin integrity or foundation of the skin. If you do all of those things, this will protect skin from infection and breakdown later.
Q: What happens if you’re lacking one of those?
A: If you’re lacking one or more of those things, then you can improve the health of your skin by focusing on improving these factors. It’s important to note that each one is affected by the others. For example, if you’re going to focus on hydration, you can’t just drink water and expect your skin to respond; it has to be hydration followed with integrity, and the skin integrity comes from good collagen (or good dermis) and good collagen or dermis comes from a good blood supply. Good blood supply involves bringing good cells to the dermis in order for us to have good collagen deposition. So that’s how everything goes one into the other. That’s why I say you need those three things: without hydration you don’t have a good blood supply; without a proper blood supply, you can’t fight the harmful bacteria which leads to a poor foundation of skin.
Q: When patients lack a good foundation, is there an immediate solution for that?
A: Yes. As a plastic surgeon, I always first examine the skin of my patients, and I examine them without gloves on to get an idea of what their skin feels like - if it’s supple or not supple - so that I can anticipate any problems and prepare them for a successful procedure and healing. If they have dry skin, I tell them to use appropriate moisturizer. If they smoke, then I often recommend they stop smoking - at least two weeks before the surgical procedure. If they’re prone to infection, then we’ll give them preoperative antibiotics. If they don’t have a good skin foundation (meaning they have a history of complicated wounds or wound issues), then we discuss with them the option to do aggressive therapy ahead of time. There’s a lot we can do to prepare someone to have optimal results with a post- surgical wound.
Q: What products or treatment methods do you recommend to minimize scarring and improve healing time?
A: Until honey products came along, plastic surgeons traditionally did things like suggesting patients massage the scar. Before that - historically, if you look back at ancient times, you see that people were applying plant oils and aloe, then we found out that maybe those things aren’t enough for wound care. Then we discovered that silicone gel was effective in wound care by offering optimal hydration and helping the skin heal better. Around 7 years ago, I was introduced to Manuka honey. We were using honey in the wound care space, but we weren’t privy to the fact that there were different types of Manuka honey. I would come to learn about medical grade Manuka honey soon enough and that made a big difference in my practice. So now, doctors like myself are recommending things like silicone gel as well as natural, medical grade Manuka honey based products.
Q: When did you learn about medical grade Manuka honey and what was your first impression?
A: I first learned about medical grade Manuka honey in 2014. We didn’t have any of the studies we have now at that time, but I had known about doctors using Manuka honey on open wounds like diabetic feet and other problems with success, and we noticed that we didn’t have to use certain antibiotics because the Manuka honey was actually doing the work of fighting bacterial growth. It became clear that Manuka was the kind of honey that had the most benefits: it had the highest level of methylglyoxal and was therefore the most potent of honeys for infection protection and wound care.
Q: Do you use it on all of your patients? Or does it depend on the situation?
A: We can’t use it on all of our patients. In our country we’re limited by insurance coverage. But, if we’re able to dispense anything within the practice or the operating room, it’s almost always a Manuka honey based product.
Q: What are the various ways you’ve used medical grade Manuka honey for both yourself and with patients?
A: In addition to using it for post surgical wounds on patients, I’ve personally used Manuka honey as a skin protectant after shaving and it works amazingly well! For patients who have contaminated wounds, we’ll use a honey ointment in the wound itself and we’ll cover with a dry dressing and have them change it everyday. We notice there’s a decreased bacterial count in these wounds over a one week period. There are also enzymatic debriders - in addition to honey products - that we use on patients, but they are considerably more expensive than Manuka honey. These are gel type products that you put on wounds - once a day along with a moist dressing - that kill the dead tissue on the contaminated wound. Manuka honey is also known to do this. We’ve found - and studies have since proven - that the over-the-counter medical grade Manuka honey products work just as well as these more expensive enzymatic debriders.
Q: Which skin conditions have you treated with medical grade Manuka honey?
A: Hidradenitis Suppurativa (H.S.) first comes to mind. H.S. is a big problem in our country and in the world. It is particularly common in young females. It is an infection that shows up most often in areas behind the neck, under the breast, in the armpit and in the groin region. It also affects young men. H.S. can lead to chronic infections - sometimes MRSA or staph, or other types of bacteria. We find that medical grade Manuka honey products work really well for these patients.
Q: Do you have experience with treating the skin condition Ichthyosis?
A: Yes, we encounter patients with Ichthyosis. We’ve used Manuka honey as a moisturizer for these patients. Ichthyosis skin is hard to heal and Manuka honey products provide the hydration and healing properties these patients need.
Q: How and why should I incorporate this honey into my daily skincare routine?
A: As always, it depends on your body and your health condition. I always recommend that patients use Manuka honey with caution. Ingesting it has been known to provide health benefits but we are still waiting to hear about the long term cardiovascular effects in studies. Topical applications such as Manuka honey cream and ointment probably offer the most immediate, positive effects, and we have solid data from clinical studies backing up these benefits.
Q: Anything else we should know about skincare and/or Manuka honey?
A: Manuka honey is becoming more and more popular and I urge people to be careful when they come across products: be sure to ask the following questions about products before you purchase and use:
- Where is the honey sourced? I.e. where does it come from?
- What is the strength of the honey? I.e. what is the potency?
Q: Lastly, a lot of people have asked how to properly change their Manuka honey dressing, especially after a minor surgery or a bad cut. Could you please provide some guidance on this?
A: When dressing a fairly clean, contaminated wound (in other words, your average wound), wash it with soap and water, then apply the Manuka honey ointment directly to the wound. Cover with a Manuka bandage or dry gauze and change the dressing once a day.