Epidermolysis Bullosa Patients' Perception of Surgical Wound and Scar Healing

Abstract

BACKGROUND There is limited evidence to suggest patients with epidermolysis bullosa (EB) have more postoperative wound complications than the general population. Despite this, the authors have noted reluctance among some surgeons to operate on these patients. OBJECTIVE A cross-sectional study was designed to investigate postoperative wound and scar healing outcomes in patients with EB. METHODS Patients were asked to complete the “Surgical Wound and Scar Healing in EB” questionnaire, and data gathered were analyzed. RESULTS Forty-six patients completed the questionnaire for a total of 94 different surgical procedures. Five patients reported blistering at the surgical wound site. All 5 had generalized forms of EB. Four patients reported wound infections, and 1 patient reported wound dehiscence. The postoperative scar healed with keloid or hypertrophic scarring after 26% of the reported surgical procedures. CONCLUSION Blistering at the postoperative site seems to be uncommon and particularly unlikely to occur in localized forms of EB. Postoperative wound infections and dehiscence are uncommon. Patients with EB may have a propensity to develop keloid or hypertrophic scarring. With these data, the authors hope clinicians have greater confidence in referring patients with EB for surgery, and surgeons more reassured about postoperative wound healing.

Recommendations on pregnancy, childbirth and aftercare in epidermolysis bullosa: a consensus‐based guideline*

“…Episiotomies and tears heal well in EB. 9,12,19,39,41,42,56 Stitches should be applied following standard obstetric practice and removed within the recommended timescale. B.15 Anti-thromboembolism management R38 ↓↓Avoid the use of compression stockings as friction caused by their application and removal may damage the skin.…”

“…Episiotomies and tears heal well in EB. 9 , 12 , 19 , 39 , 41 , 42 , 56 Stitches should be applied following standard obstetric practice and removed within the recommended timescale.…”

“…R41 ↑↑ Offer nonadherent dressings and MARS for caesarean section wounds. These generally heal well; 9 , 11 , 12 , 19 , 29 , 40 , 41 , 46 , 48 , 56 however, blistering of the scar site has been described. 9 , 20 , 56 …”

“…These generally heal well; 9 , 11 , 12 , 19 , 29 , 40 , 41 , 46 , 48 , 56 however, blistering of the scar site has been described. 9 , 20 , 56 …”

“…These generally heal well; 9,11,12,19,29,40,41,46,48,56 however, blistering of the scar site has been described. 9,20,56 C.3 Prevention of venous thrombosis R42 ↓↓ Avoid compression stockings for women with severe EB due to the unavoidable shearing forces associated with use. 12,29 Patients with EB do not appear to be at greater risk for venous thromboembolism during pregnancy/postpartum, compared with other pregnant women.…”