The rate of infections from cutaneous wounds is low because many of the surgeries are superficial. However, physicians and patients alike often use topical antibiotics routinely.¹ Routine use of antibiotics has shown no evidence of surgical site infection prevention and instead comes with a series of risks including:

• Allergic or irritant contact dermatitis
• Delayed wound healing
• Multi-drug resistant bacterial infections
• Inflammatory chondritis
• Anaphylaxis
• Stevens Johnson syndrome.

Current recommendations limit the use of topical antibiotics to avoid increasing bacterial resistance.¹ As many patients tend to self-treat with petrolatum-based products, greater research was conducted to identify the benefits and limitations of petrolatum- vs silicone-based products (Table 1).

An investigator-initiated phase IV, post-marketing prospective open-label trial was conducted to compare the use of silicone wound dressing to a topical triple antibiotic therapy in patients after Mohs surgery and excision surgery.² Findings demonstrated a 0 rate of contact dermatitis in the silicone group with a 21% rate in the triple antibiotic group (P=0.007). There were no significant differences between infection rate in either group. Healing time and quality were significantly better in the silicone group compared to the topical antibiotic group (P=0.018 and P<0.001, respectively).²

Vaginal rejuvenation (VLR) is a growing area with the market estimate to rise 26% per year and is expected to triple in 5 years.³ The United States is the largest market for VLR and is expected to expand by 30% through 2021.³ More than 500,000 procedures were performed in 2016 generating more than $500 million.³

The main health conditions addressed by VLR are reported in Table 2.

Vaginal Wall Histology and Change

The vaginal wall is composed of 4 layers; epithelium, lamina propria, fibromuscular, and adventitia. The epithelium provides protection against mechanical friction and is lubricated by cervical mucous, as the vagina does not contain any glands. Estrogen stimulates the intermediate epithelial cells to secrete glycogen, which is broken down into lactic acid as a defense mechanism against pathogens. This creates a low pH environment. The lack of estrogen more frequently found in GSM leads to atrophy of the vaginal wall, especially in the epithelial layers leading to burning, dryness, irritation, lack of lubrication, dyspareunia, urinary urgency, dysuria, and recurrent infections. Vaginal laxity is often the most common change and can be a result of:

• Multiple vaginal births
• Instrument delivery
• Advancing age
• Menopause
• Genetic disorder of collagen metabolism
• Trauma
• Excessive sexual activity.

Fractionated CO₂ lasers appear to be more effective and take less time to perform.⁴ Microscopic beams of light induce small focal zones of tissue injury and leave small bridges of tissue intact for faster healing.⁵ This also allows for thermal relaxation between ablated spots. The treatments are painless, fast (3-5 minutes), allow for deeper treatment, quick healing, and reduced side effects.^4,5

Post-treatment physical and histological changes include the contraction of collagen fibers, synthesis of new collagen and elastin, and regeneration of the vaginal mucosa with thicker epithelium and increased storage of glycogen in large epithelial cells.^4,5

• The use of silicone-based wound care should be considered in place of topical antibiotics as silicone treatment has been shown to promote healing with better outcomes.
• VLR is increasingly being performed for women with GSM, stress incontinence, and others to rebuild the vaginal epithelium alleviating symptoms related to estrogen and glycogen loss.