Dermal Clinicians and breast cancer

The previous posts have discussed in detail the effects that radiotherapy has on the breast tissue. Additionally, the common breast reconstruction procedure, the TRAM flap, was described. In this blog post we discuss how the Dermal Clinician can aid in the recovery following these procedures.


The experienced Dermal Clinician can play an important role in the recovery following radiotherapy and delayed breast reconstructive surgery. The Dermal Clinician is equip with knowledge on the application of topical preparations, dressing considerations, light-based modalities and other therapies that address all three stages of wound healing. They are able to recognise the signs of infection and wound breakdown. Furthermore, Dermal Clinician’s are able to offer nutritional and home care advice to prevent infection and improve quality of life during the recovery process.

Topical preparations and wound dressings

 Topical preparations that promote circulation and reduce inflammation have been used with success in the treatment of radio dermatitis. One example is propalis, a derivative from bees, containing flavonoids, enzymes, vitamins and minerals. Although the literature on topical propalis for radiotherapy-induced skin reactions has not been published, it has been used in other cutaneous conditions with success and is shown to reduce tissue damage. Propalis may also be beneficial following reconstructive procedures. In conjunction with topical therapies, specialised dressings can be administered by the experienced Dermal Clinician. Silver dressings are shown to accelerate re-epithelisation (wound closure), support the differentiation of fibroblasts (aid in cell maturation) and have microbial (anti-bacterial) effects. While hydrogel dressings are semi-occlusive, support a moist environment and enhance numerous growth factors to further healing.

Low level laser therapy

Treatment modalities such as low-level laser therapy (LLLT) in the 600nm range enhance all three stages of wound repair. Low-level laser therapy works by modulating processes in the body without heat, this is termed thermal free biomodulation. Energy is produced in the power house of the cell, the mitochondria, which allow the cell to function more efficiently. When cells function efficiently they speed up the recovery process and help to reduce scarring.

Low level laser therapy also has anti-inflammatory effects in the acute wound and offers analgesic effects (natural pain relief) which increase quality of life following breast reconstructive surgery.

Hyperbaric oxygen therapy

Other complementary therapies that can be performed by the Dermal Clinician include hyperbaric oxygen therapy. In small studies, it has shown to initiate neovascularization (the creation of new vessels and blood supply to the area) and increase capillary density (strength). After flap surgery, it has contributed to the success of free flap adhesion. However, more studies are required to verify the success rates specific to the TRAM free flap following radiotherapy.

Home care advice

As the Dermal Clinician has extensive knowledge in general skin health they can successfully educate the patient on how to care for surgical sites at home. A prospective study reported that radiodermatitis is effectively managed when patients followed a basic skin care regime. The same principals can apply post-operatively for Breast Reconstruction procedures once wound edge approximation has taken place and drains have been removed. The regime includes gentle washing, routine dressing changes to moisten and protect the area and careful observation of signs of infection.

Nutrition

Finally, nutritional guidance can be shared by the Dermal Clinician. As an example. the amino acid glutamine is found abundantly in the body and is a necessary component of gene transcription for collagen. As an oral supplement, it has shown to normalise collagen production in irradiated tissue. Later blog posts will discuss nutritional considerations for wound healing and optimal skin health.

To find out more about the conditions that can be treated by an experienced Dermal Clinician Click Here for a link to the Australian Society of Dermal Clinicians.

Marnina Diprose holds a Bachelor Health Science in Dermal Therapies, and a Vocational Certificate of Laser and Light. Marnina has a strong passion in scar revision and holistic approaches to patient care. For media inquiries or if you have an interest in blog contribution please email info@arozedermaltherapies.com.au


References

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Dell, D., Weaver, C., Kozempel, J., & Barsevick, A. (2008). Recovery After Transverse Rectus     Abdominis Myocutaneous Flap Breast Reconstruction Surgery. Oncology Nursing Forum,     35(2), 189-196.

de Moraes, J., Eterno de Oliveira Mendonça, D., Moura, V., Oliveira, M., Afonso, C., & Vinaud, M.     et al. (2012). Anti-inflammatory effect of low-intensity laser on the healing of third-degree     burn wounds in rats. Lasers In Medical Science, 28(4), 1169-1176.

de Moraes, J., Eterno de Oliveira Mendonça, D., Moura, V., Oliveira, M., Afonso, C., & Vinaud, M.     et al. (2012). Anti-inflammatory effect of low-intensity laser on the healing of third-degree     burn wounds in rats. Lasers In Medical Science, 28(4), 1169-1176.

Ebeid, S., Abd El Moneim, N., El-Benhawy, S., Hussain, N., & Hussain, M. (2016). Assessment of     the radioprotective effect of propolis in breast cancer patients undergoing radiotherapy. New     perspective for an old honey bee product. Journal Of Radiation Research And Applied     Sciences.

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Rocha, B., Gombar, F., Barcellos, L., Costa, W., Barcellos Sampaio, F., & Ramos, C. (2011).     Glutamine supplementation prevents collagen expression damage in healthy urinary bladder     caused by radiotherapy. Nutrition, 27(7-8), 809-815.

Zenda, S., Ishi, S., Kawashima, M., Arahira, S., Tahara, M., & Hayashi, R. et al. (2012). A     Dermatitis Control Program (DeCoP) for head and neck cancer patients receiving     radiotherapy: a prospective phase II study. International Journal of Clinical Oncology,     18(2), 350-355.

Zecha, J., Raber-Durlacher, J., Nair, R., Epstein, J., Sonis, S., & Elad, S. et al. (2016). Low level     laser therapy/photobiomodulation in the management of side effects of chemoradiation     therapy in head and neck cancer: part 1: mechanisms of action, dosimetric, and safety     considerations. Support Care Cancer, 24(6), 2781-2792.

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