Cleansing, moisturizing and skin protection in Vascular Surgery

Skin cleansing

Daily skin cleansing, at any age is an important and essential procedure for our own care, since it not only removes dirt or any bacteria from the skin, but also the dead surface skin cells, preparing the skin to better absorb the topical treatments (drugs/creams).
Common problems such as irritation, xerosis, dermatitis, eczema, psoriasis, acne, rosacea, and photodamage, leave the skin vulnerable to external insults mainly due to an alteration of the stratum corneum (SC) skin barrier.
In the daily skin cleansing is therefore important to minimize any further weakening of the stratum corneum barrier, using mild and emollients cleansers, with neutral or acid pH (about pH 5.5) that do not attack or alter this barrier causing dryness, irritation and itching.

Defenses against dehydration

The structure of the skin acts as a barrier essential to maintain hydration of the skin within physiological values. The main factors of this barrier responsible for maintaining hydration are:

  • The Stratum corneum
  • The Epidermal lipids
  • The Natural moisturizing factor (NMF)
  • The hydro-lipid film surface

These components are subjected to a continuous renewal process determined by the ability of the epidermal keratinocytes to reproduce and differentiate continuously, thus giving rise to the various layers of the epidermis.
Different factors, both exogenous and endogenous, may affect these fragile defense mechanisms, causing lower or higher skin dehydration. The extent of skin hydration depends on the humidity, the hygroscopic properties of the stratum corneum and the presence of naturally moisturizing factors, without which you have dry skin. In addition to age and genetic predisposition to skin aging, many external factors can lead to lower or higher skin dehydration. The main factors of dehydration are chemical (eg, the solvent action and loss of skin lipids caused by the continuous use of surfactants) or due to unfavorable climatic or environmental conditions: wind, cold, and humidity, separately or in combination, cause dehydration of the stratum corneum leading to dry, rough, scaly and cracked skin, redness, itching and irritation. Even prolonged contact with water, despite the protection of the sebaceous-sweating film, causes a depletion in NMF. Indeed, a topical application of water alone causes a stress on all the stratum corneum that causes an alteration of its barrier function. The more exposed areas, such as face and hands, are the most affected; however also other areas of the skin are particularly prepared to excessive dryness often associated with a more or less evident flaking skin.

Skin dehydration: Interventions

A dehydrated skin favors the entry of foreign substances, the onset of inflammation and causes loss of elasticity and tone. The application of topical cosmetic formulations on the dehydrated skin is able to restore smoothness, softness and distensibility. Therefore it is necessary to intervene with moisturizing treatments that prevent skin dehydration, and at the same time restoring the optimal content of water and other substances, which may be impaired as a result of multiple factors. Topical treatments are able to intervene on the hydration of the stratum corneum and also to convey compounds able to bring water, and to restructure the skin barrier which is essential to effectively replenish and restore the water and lipid content of the skin (collagen, hyaluronic acid, urea, ceramides, plants lipids and fatty acids treatments). The moisturizing efficacy of a formulation is due not only to the presence of specifically moisturizing ingredients, but also to the choice of vehicle and cosmetic form that contributes to the transfer of such property.

RSS Journal of Vascular Surgery

  • Complex Relationship Between Low Albumin and Poor Outcome Following Lower Extremity Procedures for Peripheral Arterial Disease May 26, 2020
    Low albumin has been associated with poor outcome, including death, in surgical patients. The mechanistic relationship, however, is more complex than simply nutritional. As studies are scant in the vascular population, we sought to examine the association of low albumin with outcomes in patients undergoing open and endovascular lower extremity procedures for peripheral arterial disease […]
    Jonathan Bath, Jamie B. Smith, Jennifer Woodard, Robin L. Kruse, Todd R. Vogel
  • Elective late open conversion after EVAR is associated with comparable outcomes to primary open repair of abdominal aortic aneurysms May 26, 2020
    Three out of four patients with infrarenal abdominal aortic aneurysm (AAA) are now treated with endovascular aneurysm repair (EVAR). The incidence of secondary procedures and surgical conversions is increasing for a population theoretically unfit for open surgery. The indications and outcomes of late open surgical conversions (LOC) after EVAR in a high volume tertiary vascular […]
    Robin Chastant, Ludovic Canaud, Baris Ata Ozdemir, Pierre Aubas, Nicolas Molinari, Eric Picard, Pascal Branchereau, Charles-Henri Marty-Ané, Pierre Alric
  • Dual Fluoroscopy with Live-Image Digital Zooming Significantly Reduces Patient and Operating Staff Radiation During Fenestrated/Branched Endovascular Aortic Aneurysm Repair (F-BEVAR) May 26, 2020
    Fenestrated/branched endovascular aneurysm repair (F-BEVAR) is a complex procedure that generates high radiation doses. Magnification aids in vessel cannulation but increases radiation. The aim of the study was to compare radiation doses to patients and operating room staff from two fluoroscopic techniques, standard magnification vs. dual fluoroscopy with live-image digital zooming during F-BEVAR.
    Laura I. Timaran, Carlos H. Timaran, Carla K. Scott, Marilisa Soto-Gonzalez, David E. Timaran-Montenegro, Jeffrey B. Guild, Melissa L. Kirkwood
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    Chronic exertional compartment syndrome (CECS) is an overuse injury typically seen in young and athletic patients. The five cardinal symptoms are pain, tightness, cramping, weakness and paraesthesia. These classically occur during exertion and disappear with cessation of the activity, with no permanent damage to tissues within the compartment; nonetheless, CECS presents a significant functional impairment […]
    Anni Ding, Matthew Machin, Sarah Onida, Alun Huw Davies