Vinegar, Silver, Honey, Leeches and Cocaine the Weird and Wonderful Specialty that is Plastic Surgery
About the author: Dr Jack Zoumaras is a Specialist Plastic Surgeon, Founder of Artiste Plastic Surgery and current Hon. Secretary of the Australian Society of Plastic Surgeons.
Dr Jack Zoumaras is an expert on the face, a Facelift Plastic Surgeon based in Sydney, Australia.
Plastic Surgery comes from the Greek word plastikos meaning “to mold and to shape”
A wound is a defect in the tissue of the skin, such wounds have a number of causes and when wounds don’t heal in a timely fashion they need more expert care and even surgery.
Plastic surgery is a wound based specialty and at a research level plastic surgeons are at the forefront of technology for wound dressings and wound biology. Even cosmetic surgery patients have wounds especially in large body contouring patients or the smoking patient.
As such Plastic Surgeons are the surgeons surgeon when it comes to wound advice and are experts at wound management. One look in my treatment room will reveal a cocktail of dressings.
I will enlighten you on some of the dressings, in this blog and also include some old fashioned yet first line treatment still used today in hospitals all around the world.
Vinegar has been used for wound care for centuries and is one of the go to agents for resistant infected wounds. Pseudomonas is a common gram negative bacteria that loves to grow in moist wound environments and acetic acid (Vinegar) is the best treatment for such a wound. Despite vinegar being the best treatment it is more time consuming and has a rather noticeable odour. For this reason the mainstay in modern society for pseudomonas is silver dressings….more about silver later.
Vinegar is formed from the fermentation of grapes that forms alcohol or ethanol and with the passage of time ferments to vinegar or acetic acid. Vinegar is the French word for sour wine, hence the old saying that bad white wine is vinegar!
Vinegar is used as a topical agent to clean an infected wound and to moisten gauze to dress on a wound to de-contaminate. The odour is like “fish and chips” but it works and I have personally used it on infected burns, complex leg wounds and to irrigate contaminated wounds.
Vinegar or acetic acid can be bought as retail or made by a pharmacist for under $10, however due to hospital protocol and due process the more expensive silver dressings are used today which cost $70 a sheet.
In my office I get acetic acid formulated by a pharamacist, the photo illustrated above is from a older mentor who has used supermarket acetic acid in other words….Vinegar.
Silver is a metal on the periodic table and has been used in burn surgery as a cream for decades for its antimicrobial effect. Over the last 20 years a nanocrystalline formulation of silver has been used as sheets for dressings with the Smith and Nephew product Acticoat. This formulation releases silver at 60 parts per million and requires water for activation.
Silver works by killing microbes and promoting wound healing. It destroys microbes by binding to the electron transport chain of the organisms rendering them dysfunctional.
Today silver dressings such as Acticoat or Mepilex Ag (foam) are used to speed healing wounds post surgery and to deal with infected wounds all over the body.
In my office i have a lot of Silver based dressings and use for all wounds especially recalcitrant ones.
Honey has been used by doctors and physicians for centuries to heal battle wounds in ancient times and to aid the treatment of digestive issues. Manuka honey in particular gets a lot of the attention as the majority of laboratory based research has been done on this form of honey. Manuka bush is a native to New Zealand and bees pollinate to produce Manuka honey.
Manuka honey or any honey can be consumed once or twice a day for its antibacterial properties, but in the setting of a plastic surgery clinic it is used topically over the wound.
I have used honey on chronic wounds but do not have honey in my office at the present time.
Leeches are a type of worm that has been used in medicine since the ancient Egyptians. Today Leeches are still used in modern plastic surgery hospitals. Almost all plastic surgery operations involve raising a flap (Face lift flap) and when this flap becomes congested (lack of venous output) leeches are a mainstay of treatment. The leeches have fine teeth and a sucking mechanism that enables them to suck blood 10 times there body weight. So the use of a few leeches over 5 days can save a flap. 5 days is the magic time it takes your own body to make new veins.
The leeches used in plastic surgery although medicinal leeches are everyday leeches that are harvested and farmed in small hospital aquariums. For example a ‘Leech Farm’ is present in Liverpool hospital, Sydney which supplies leeches 24/7 to surgeons around Sydney by taxi (or Uber today). Such leeches are grown in a aquarium and sent to doctors as required. Once the leeches have worked for the day they are purged and re-used.
Cocaine is a banned narcotic across most of the world, it is formed from the coca plant that is prevalent in South America. The indigenous population of South America where known to chew coca plants and enabled them to work long hours and stay alert (via its now known stimulatory effect). Early in the 20th century cocaine was experimented on in Vienna and elsewhere in the world. It is a drug of addiction and involved in large illicit trading, hence its banned.
Cocaine is renowned for its strong analgesic and vasoconstrictor properties. It is commonly used in Rhinoplasty surgery. My preference is to use cocaine topically on the nasal septum to reduce bleeding and reduce anaesthetic requirements (via its analgesic properties). This allows meticulous execution of operative technique.
The cocaine comes as powder that we reconstitute with salt water based on a maximal dose. The hospital sources the cocaine via pharmacy but where they get it from me is an intriguing question. It is not synthetically made…..
It is not addictive as a one off hospital use while undergoing surgery.