Prevention first, prevention and treatment combinedof secondary prevention thinking
From the perspective of clinical medicine, it is to propose a system plan that is as perfect as possible, and from the perspective of public health, it is to reduce the incidence rate, reduce the rate of severe disease, and reduce the pressure on the investment of social resources. Therefore, the current diagnosis and treatment ideas at home and abroad are a combination of the two, which is in the dimension of secondary prevention.
Preventive medicine strategies are classified as primary, primary, secondary, and **.
At the beginning of the 20th century, the concept of preventive medicine was first coined by Sarah Josephine Baker, and "primary prevention" was coined by Hugh Riverer and Gurney Clark in the 1940s. They worked at Harvard University and Columbia University's School of Public Health, respectively, and later expanded the level of prevention to include secondary and ** prevention. s. e.Goldston noted in his 1987 book that while the terms primary, secondary, and prevention are still in use today, these levels are used"Prevention,** and rehabilitation"It would be more appropriate to describe it.
Primitive-level and neonatal prophylaxis: anything aimed at helping incoming parents, providing adequate attention for the approaching newborn, and providing a safe physical and emotional environment for the newborn from conception to birth. Neonatal prophylaxis is concerned with preventing the development of risk factors in the early stages of life.
Primary prevention: by eliminating the causative agent, or by increasing the resistance to the disease. For example, vaccination, maintaining a good diet, developing exercise habits, and avoiding smoking.
Secondary prevention: Detection before symptoms appear, and there are ways to deal with the disease. Examples include dealing with high blood pressure (a risk factor for cardiovascular disease) and screening for cancer.
Prevention: Mitigation of injuries from symptomatic diseases, such as disability or death, through or rehabilitation. For example, surgery is performed to prevent the spread or worsening of the disease.
Level 4 prevention: Ways to stop or avoid unwanted or unnecessary medical interventions.
It can be seen that our prevention of pathological scars starts from "secondary prevention", that is, at the first time of trauma, the risk of scarring is assessed, and the control and ** are carried out within the scope of ability.
Risk estimation is analyzed from two dimensionsBasic conditions for physical fitnessandTraumatic nature
In the past, a concept called "scar constitution" was often mentioned for patients with scars, but a recent literature study has concluded that the concept of "scar constitution" cannot be used universally and as a diagnosis.
Scar constitution is generally considered to have the following characteristics:
Multiple patients in the family, with a genetic predisposition;
Keloid-like hyperplasia can occur in different parts of the body and at different times of the patient's body due to injuries of different causes, even if it is inadvertently minor.
Dr. Cai Jinglong analyzed this conclusion through the counter-evidence of the case, and put forward the hypothesis that the scar constitution is as high probability as we think.
Then a few inferences are proposed:1During his more than 20 years of scar professional medical work, he should have been exposed to a very large number of cases; 2.Keloids or hypertrophic scars formed by the same trauma should be consistent in the same patient; 3.The same patient has multiple similar scars, and there should be a similar effect in **.
The reality is that in his career, there are very few patients who meet the above diagnostic criteria; The clinical types of multiple scars in patients who are judged to be "scar constitution" are diverse, and there are significant differences in the effect.
Therefore, he believes that the concept of "scar constitution" is misleading to both doctors and patients in the case of insufficient diagnostic value, and both doctors and patients are negative as a result, and patients may have psychological burden.
Epidemiologically, there is a bias between gender and age in the onset of scarring, with a slightly higher distribution in females and younger adults.
The patient's personal and family history is of great reference value, and if the patient has had a large and obvious scar before, that is, pathological scarring, then the iatrogenic injury associated with the trauma or surgery is also more likely to have pathological scarring. Even in the absence of a medical history, neck and chest surgeries are more likely to cause scar growth than other areas, which may be some of the problems that thoracic surgeons and head, neck and maxillofacial surgeons need to explain before surgery, and the execution of such surgeries requires the preparation of a plan for the management of postoperative scar growth.
In addition to the assertion that "scar constitution" should not be believed, family history and personal history cannot be easily ignored.
So share it belowTrauma and iatrogenic factors
In the general public's perception, the scar of a cut injury will be smaller than that of a crushing injury; Superficial wounds will hardly leave scars, and deep involvement under the dermis often scars, the more involved multi-layer tissue structures, the higher the risk, we can encounter clinically because the debridement removes too much superficial and deep fascia and muscle tissue, the epidermis directly heals on the surface of the bony structure, fortunately the wound is covered at the same time, you should know that the life and functional experience of "close bone scar" is very poor, surgical removal of scar, choose local or free flap coverage is a choice worth considering.
Among the many causes of trauma, burns are very, very important, followed by similar thermal and chemical burns, and the risk of scar healing is higher than that of other wounds, regardless of size.
We have confirmed that the main purpose of the growth of scar is to repair the open wound, and once the wound is formed, the tension of the surrounding tissues is an important factor in the relative size of the wound change, and the larger the wound and the more layers, the possibility of the orderly arrangement of fibrin and collagen decreases significantly, and the chaos will dominate the direction of wound healing for a long time, and the local tissue tension is too large, which has a natural advantage in stretching and expanding the wound, and therefore in the area with higher tension on the surface of the elbow and knee in the chest and back. Scarring is more likely, so it is important to remember the importance of local reduction when dealing with trauma and surgical incisions, and even to control local postoperative swelling with cold therapy.
Among the iatrogenic injuries, the most disturbing are postoperative infections and repeated surgeries due to poor surgical design, as well as problems such as multiple skin grafts, mesh skin grafts, and stamp skin grafts, that is, if you are given about 30 minutes of thinking and designing an individualized multiple surgery plan, then the number of surgeries should be minimized, and the necessity of perioperative local care should be effectively guided! In other words, it is better to do things delicately than to operate extensively! From the perspective of plastic surgery, the words "don't get tired of eating, don't get tired of fine", there is nothing wrong with it, covering the wound is never the end, and the examination and pursuit of beauty is the ultimate goal!
The awareness of prevention, we have broken and shared for a long time, I don't know if you are a little tired? To sum up, establish the concept of scar prevention at the beginning of trauma; And when the scar has already appeared, don't lower the aesthetic requirements, be meticulous, and try not to let it come out again**; And for the setback of failure, don't easily put forward fatalism, scar constitution, it's not so common!