Depilation Feasibility PPI: The Impact of Depilation upon Wound Healing and Post-Surgical Complications: A Feasibility Study (The DEPILATION-Feasibility STUDY) - Patient and Public Involvement

Project Description

Wound complications such as infection or dehiscence (where all or part of the wound bursts open) are the most common complication following surgery. The cost of infection alone to the NHS may be upwards of £700 million every year.

Infections are more common in areas where there are natural skin folds, such as the groin or the armpit, as they are warm and moist, and their location can make it more difficult to maintain a clean, hygienic environment both before and after an operation.

Operations may be undertaken in the groin or armpit when a patient is diagnosed as having cancer, often of the skin, breast or genital regions. To see whether the cancer may have spread via the lymph nodes, an operation may be undertaken to sample one or more of the nodes in the armpit or groin. Lymph nodes are part of the lymphatic system, which is made up of vessels (similar to blood vessels) that drain away excess fluid from the body. Large collections of these lymph nodes can be found in the armpits, groins, and the neck area. Lymph nodes are part of the immune system to fight infection, but also filter cancer cells. If a cancer has been found after sampling these nodes, an operation to remove the nodes completely may be undertaken.

An infection or other wound complication after an operation such as this may occur in up to 50% of patients. As well as causing significant problems at the time, such as repeated trips to hospital, courses of antibiotics, more time off work and the potential to make patients very unwell, infection after lymph node surgery may increase the risk of lymphoedema, or long-term swelling of the entire limb.

Strategies to reduce wound complications are in high demand, especially with the current threat of antibiotic resistance. One such strategy that our team has been working on is hair cycle modulation. Hair follicles cover the entire body, but are concentrated on the head, in the armpits and groins and on the face in men. They contain a large number of skin stem cells, that have been shown to migrate out of the hair follicle and contribute to wound healing when the surrounding skin is injured, such as when an incision is made.

Early evidence suggests that these stem cells are most active when the follicle is naturally in a growth phase. Forcing the follicle into a growth phase may maximise the effect of these stem cells on healing and contribute to a reduction in complications. Hair follicles can be forced into a growth phase by removing the strand of hair from within, by plucking or waxing.
Our team has conducted a research study in patients having skin graft surgery, where we waxed the thigh where a graft was taken from. This was tolerable to patients and shows promising results. However, we cannot be certain whether it will be effective on a larger scale and in other parts of the body, and on wounds created with a surgical blade and stitched closed at the end of the procedure. We also do not know, if it is effective, how this will compare to other strategies, such as wound dressings or negative pressure devices (dressings which apply a low level of suction to the wound). We are proposing a research study where patients undergoing surgery to the lymph nodes are allocated at random to have the skin where their operation will take place either waxed a few days before the operation, or the hair cut with clippers the day of the operation as per standard practice. We may also compare this with a particular type of wound dressing, which applies a mild form of suction to the wound for up to one week. We are looking for a patient involvement group to find out whether patients would find this acceptable, and be willing to enter such a research study.