EXCISIONAL SURGERY INFORMATION

PRE OP INSTRUCTIONS | ACTIVITIES | SUTURE REMOVAL
POST OP INSTRUCTIONS | COMPLICATIONS | CHANGING OF THE DRESSING | LONG TERM HEALING

PRE OP INSTRUCTIONS

Please stop all alternative treatments one week before surgery, as it is unknown what effect these substances may have on bleeding and wound healing.

Garlic, ginkgo, licorice extracts and Vitamin E, at or over 400 units, increase bleeding.

Please stop arthritis type meds such as Advil, Motrin, etc. Tylenol is fine.

Aspirin taken for general purposes should be stopped six days prior to surgery.

If aspirin is taken for prior history of stroke or cardiac events, check with your appropriate doctor to see if it may be stopped four days prior to surgery.

Aspirin may be resumed two days after surgery, if no unusual bleeding has occurred.

Coumadin is not stopped for surgery, as it is given for serious medical problems. However, we need to have an INR no more than one week and no less than 3 days prior to surgery.

Surgery will be cancelled if INR is greater than 3.4.

ACTIVITIES

No strenuous activities for at least 72 hours after surgery. If a flap or graft is performed, no strenuous activities for one to two weeks.

If surgery is on a lower extremity, keep elevated while sitting and minimize standing.

SUTURE REMOVAL

Facial sutures-usually removed in 5-8 days

Non-facial sutures-usually removed in 7-14 days

Lower extremities and back- usually removed in 2 weeks

POST OP INSTRUCTIONS

1. No strenuous activities for at least 72 hours.

2. Elevate area as much as possible, if on an extremity.

3. Minimize bending over, if on the head and neck.

4. Change dressing in 24-72 hours. If dressing becomes wet, it needs to be changed.

5. Pain is usually relieved by Tylenol and ice compresses.

COMPLICATIONS

1. If the area is bleeding, apply direct pressure to the area and do not release for 15 minutes- use a timer. Call office and continue pressure if bleeding continues.

2. Some pinkness and mild discomfort is normal in the early post-operative period. If the area gets redder and more swollen and accompanied by increasing pain, the site is probably infected and the office should be called. Some pinkness/redness is normal around each suture as it gets closer to the suture removal time. The incision itself is usually not red. This reaction to the sutures is minimized by keeping the area covered.

3. Swelling-Gravity will determine where the majority of swelling occurs. Swelling may be prominent in the eyelid area as the skin is loosely attached. Swelling is usually most obvious upon awakening, when the surgery is in the eyelid area. Swelling may impede healing, particularly on the lower legs. Swelling may be reduced by cold compresses, elevation, and compression with an Ace wrap, if appropriate.

4. Hematoma-A hematoma is caused by bleeding underneath the suture site. Evidence of a hematoma is rapid swelling and distension of the surgical site usually in the first few hours after surgery is performed. The office should be called, so the collection of blood may be released.

CHANGING OF THE DRESSING

TYPICAL SUPPLIES

  1. Vaseline. Topical antibiotic such as Polysporin, Neosporin, Bacitracin, Bactroban or Centany is discouraged unless area is in an infection prone site. Antibiotic usage can lead to allergic reactions or the development of bacterial resistance.
  2. Non-stick gauze, such as Telfa
  3. Paper tape
  4. Hydrogen peroxide
  5. Optional: Wound wash saline (saline in a pressurized can, available at most pharmacies)
  6. Ace wrap

ALTERNATIVE SUPPLIES - These would be used in hard to reach areas with limited at-home assistance. Waterproof dressings may be applied and if, the dressing stays intact, can be changed every 3-5 days.

TYPICAL DRESSING CHANGE: Initial dressing change at 24-72 hours and subsequent dressing change when bathing, or at least every 48 hours. Keep area dry until time to change the dressing. The dressing applied in the office will be big and bulky, as it is a pressure dressing to decrease the chance of bleeding. Soaking the dressing in the shower will help to loosen it, so it is easier to remove. Wash the area gently with soap and water. Any dried blood can be loosened with hydrogen peroxide. If material cannot be easily removed, don't force it. Hydrogen peroxide should not be used if, there is no adherent material. Wound wash saline may be helpful to cleanse the area. Another option to cleanse the wound is 1/2 strength vinegar. This is often useful on the scalp and the legs.

Dry the area: Apply thin film of vaseline or, if instructed to do so, antibiotic.
Apply non-stick gauze trimmed to just cover the excision and sutures.
Apply paper tape.
Apply Ace wrap if appropriate.

ALTERNATIVE DRESSING CHANGE:

If you require assistance for your dressing change, you may want to use a waterproof dressing. Change initial dressing at 48 to 72 hours.

Apply vaseline to sutures then waterproof dressing.

Change every 3-5 days or, if becomes loose or, tenderness increases at the wound site.

Dressing Won't Stick:

Try cleansing area surrounding sutures with rubbing alcohol- skin oil or vaseline may have spread interfering with adhesion.

Go light on the vaseline.

SUTURE REMOVAL

Keep appointed suture removal time in the office.

The sutures will be removed and steri-strips will be applied to the sutured site.

No further care needs to be done unless instructed otherwise. The steri-strips may be removed in one week if they have not fallen off prior to this time.

LONG TERM HEALING

Incisions on the face usually heal very well without raised scars; however, procedures done on the upper torso and shoulders often go through a phase where the scar will raise up, be pink, a little itchy and sensitive for several months. Usually, this raised scar will resolve on its own. However, if it is very symptomatic, a cortisone injection may be used to hasten this process. The healing period occurs very actively over the first six months postoperatively and then much more slowly over the next 18 months. Generally, scars will be pink, when they are new, and white when they are old. Every attempt will be made to place the incisions in natural skin lines, if possible. The only postoperative care which seems to help scars be less noticeable is to keep them covered. It probably does not matter too much what substances are used to keep them covered, just keeping them covered works. Many silicone dressings are made for this purpose. Mederma is an over-the-counter product, which is an extract of onion that is promoted for minimizing wounds. There is minimal scientific evidence to support this product; however, the massaging of the area as the Mederma is applied may be helpful for some raised scars. It would not be necessary in flat scars. Vitamin E products on freshly healed skin are often irritating and should be avoided. In particular, there are quite a few cases of irritation from pricking a vitamin E capsule and applying it directly to the wound, so this is discouraged.

 

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