[Treatment of surgical site infection and hypertrophic scars]

For the treatment of surgical site infection (SSI), removal of foreign body materials and débridement of infected/necrotized tissues should be performed after careful imaging diagnosis. Then, wound irrigation should be performed everyday. For critically colonized wounds, iodine preparations are useful. If healthy granulation tissues start to grow, wound dressing with the basic fibroblast growth factor (bFGF) spray and/or prostaglandin E₁ (PGE₁) ointment should be recommended. Poor increase in granulation tissues, is a good indication for vacuum assisted closure (VAC) therapy. In Japan, the V.A.C. system is the only device for negative pressure wound therapy (NPWT) that is covered by the health insurance scheme. If entire wounds are covered by healthy granulation, chest wall reconstruction using skin graft or flap can be considered. For the treatment of hypertrophic scars (HSs), multimodal therapies should be performed. Tranilast and/or Saireito are widely used as internal agents in Japan. Corticosteroid ointments/creams/tapes/ injections are useful to decrease chronic inflammation in HSs. Moreover, wound stabilization, compression and keeping the affected area moist are effective to decrease subjective symptoms including itch and pain. Surgery, radiation therapy, pulsed dye laser, neodymium yttrium aluminum garnet(Nd:YAG) laser, make-up therapy such as rehabilitation make-up should be selected on a case-by-case basis.