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

  • Left Vertebral Artery Revascularization in Distal Aortic Arch Surgery: Comparative Study of Patients With and Without Aberrant Left Vertebral Anatomy October 1, 2023
    Left vertebral artery revascularization is indicated in surgery involving zone 2 of the aortic arch and is typically accomplished indirectly via subclavian artery revascularization. For aberrant left vertebral anatomy, direct revascularization is indicated. Our objective was to compare outcomes of indirect subclavian artery and direct vertebral artery revascularization for the treatment of aortic arch pathology.
    Eimaan Shergill, Farhad R. Udwadia, Maja Grubisic, Konrad Salata, Jonathan Misskey, Jason Faulds
  • Fibromuscular dysplasia incidentally identified with computed tomography angiography October 1, 2023
    A 78-year-old woman had presented to the emergency room with altered mental status after the inadvertent consumption of a cannabis product. A stroke workup was initiated, including computed tomography angiography, which demonstrated severe tortuosity and a beaded appearance of her bilateral internal carotid arteries (A/Cover and B). The radiographic imaging findings, including alternating areas of […]
    Henry Lee, Bethany Lueck, Kevin M. Casey
  • Socioeconomic Factors Predict Successful Supervised Exercise Therapy Completion October 1, 2023
    Supervised exercise therapy (SET) for patients with intermittent claudication can lower the risk of progression to chronic limb threatening ischemia and amputation, while preserving and restoring functional status. Despite supporting evidence, it remains underused and among those who initiate programs, attrition rates are extremely high. We hypothesize that socioeconomic factors may represent significant barriers to […]
    Jack Donohue, Marissa Jarosinski, Katherine Reitz, Yekaterina Khamzina, Jonathan Ledyard, Nathan Liang, Rabih Chaer, Natalie Sridharan
  • Guideline-concordant Arteriovenous Fistula Care With the PREDICT-AVF Web App October 1, 2023
    The aim of this study was to develop a tool for prediction of arteriovenous fistula (AVF) outcomes and guide shared decision-making about access appropriateness and futility in the context of recent Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines. KDOQI guidelines discourage ongoing hemodialysis access salvage attempts after two interventions prior to successful use or three […]
    Patrick Heindel, Tanujit Dey, James J. Fitzgibbon, Dirk M. Hentschel, Michael Belkin, C. Keith Ozaki, Mohamad A. Hussain