WOUND CARE AFTER SURGERY
After surgery, make sure to rest.
Leave the pressure dressing on for 48 hours. If the pressure bandage starts coming off around the edges, you may need to reinforce it.
You may apply ice to the surgical site to reduce swelling and pain. Apply ice for 20 minutes, then take a 20 minute break before resuming.
Minimal bleeding/drainage is normal. If the wound is bleeding and the blood has saturated the bandage and is leaking out of the bandage, please remove the bandage and apply firm, continuous pressure for 20 minutes using clean towels or tissues. If it continues to bleed, hold an ice pack over the clean towels or tissues and repeat holding pressure for another 20 minutes.
If the bleeding stops, apply a dressing to the area and start wound care as described below. If the bleeding does not stop, call the office to get in touch with your surgeon or go to the Emergency Room if it is after hours.
Remove the pressure dressing in 48 hours. If it is difficult to remove, soaking the gauze with water, or applying vaseline around the edges of the bandage for a few minutes before removing is helpful.
You may have dissolvable sutures, non-dissolvable sutures, staples or an open wound.
If your sutures are dissolvable, you do not need to return for a follow up unless there are complications or concerns with the wound healing process. Follow the instructions below until your sutures have dissolved.
If the sutures are non-dissolvable or you have staples, your doctor will instruct you to schedule an appointment for suture removal in 7 or 14 days. Continue the wound care instructions below until your suture removal appointment.
If you have an open wound, continue the wound care instructions until your open wound is closed with fresh new skin.
Unless your doctor instructs otherwise, follow these wound care instructions:
Perform the following wound care twice a day:
1. Remove the dressing
2. Wash the surgical site gently with soap and water, then pat dry.
3. Apply an ointment (examples include Vaseline or Aquaphor). Do not use Neosporin, bacitracin or other over the counter antibiotic ointments as these can cause allergic reactions, even if you have used them without a problem in the past. The doctor may recommend a prescription ointment such as mupirocin or gentamicin— if so, use that instead of Vaseline.
4. Cover with a bandage or non-stick gauze pad with medical tape.
If the wound is on your face, leave the Steri-Strips on for four days. Then, remove the Steri-Strips and apply Vaseline to area for 1 week.
If the wound is elsewhere on your body and there are Steri-Strips in place, you can leave them on until they fall off OR remove them in 2 weeks and then apply Vaseline to area for 1 week.
Do not use Vaseline while Steri- strips are on because it makes the Steri-strips fall off too early.
After you stop using Vaseline, you can start applying sunscreen to area prior to going outdoors.
You will leave the office with two large pressure dressings — one at the site where your skin cancer was removed, and another at the donor site, where the doctor removed a piece of skin to cover the wound.
At the graft site (where the skin cancer was removed), you should keep the pressure dressing on and dry until you return for your wound check appointment in 7 days.
If the bandage loosens or accidentally gets wet during that time, you may remove the bandage and wash the wound very gently with soap and water. Gently pat the wound dry and apply a generous amount of Vaseline under a bandage or non-stick gauze pad with medical tape. Repeat this once daily until your wound check appointment. Please note that the graft may appear very dark, pink to purple, or even crusted..
At the donor site, you can remove the pressure dressing after 24-48 hours. The wound at this location will be covered with Steri-Strips, and no special care is required— simply leave the Steri-Strips in place.
For most open wounds, you will be asked to follow the general wound care instructions.
The wound site will heal on its own without stitches. The wound will heal from the outside edges into the center. It is important to keep the ointment on the wound so a scab does not form. The body will produce its own tissue to fill in the surgical wound and will become level with the surrounding tissue area. The edges of the wound will become slightly reddened and you may see some yellowish matter inside the wound. This is the normal appearance of a healing open wound. These are not signs of infection. As you clean the wound, there may be some pinpoint areas of bleeding from the base.
In some cases, you may be asked to order (from Amazon.com or local pharmacy) a special dressing called DuoDERM (Convatec brand, Extra thin). You should do this on the day of your surgery so that you will have it ready when you remove the pressure bandage. You can cut this dressing to the correct size for your wound. The dressing should cover the entire wound.
One or two days after your surgery, you can remove the large pressure dressing. Wash the wound gently with soap and water, and pat dry.
If you are using DuoDERM, simply apply the dressing to the wound and change it every 3 days, or sooner if you notice drainage seeping out from dressing. When it is time to change the dressing, remove it when you are in shower as there may be drainage under the bandage. You may shower with the DuoDERM dressing in place on the other days. There is no need to apply ointment under the DuoDERM.
Swelling, redness, bleeding/bruising, itching, tightness and tingling around the surgical site is normal and should improve over time. It may take up to 18 months for the scar to completely heal. Numbness can also occur on or near the site.
Pain at the site of your surgery is normal after surgery. You may take Extra Strength Tylenol per the directions on the bottle. You can begin as soon as you get home. Advil (Ibuprofen) and Aleve (Naproxen) can lead to increased bleeding post-operatively, but if you cannot take Tylenol (or Tylenol does not work for you), you can use these pain medications instead.
You should not do strenuous activity (such as exercise, bending, or lifting) for a minimum of 1 week following your surgery. You may resume gentle activity (such as walking) after three days as long as the surgery site is not on your legs and you have not had post-operative bleeding from the site. Avoid movements that stretch or strain the surgical site. This could cause the surgical site to open, resulting in prolonged wound healing and a widened scar. Do not swim for at least two weeks following your surgery.
Wounds on the leg heal slowly. Please keep your leg elevated as much as possible to help reduce swelling in the first 2 weeks. This is especially important in the first week after surgery. You may be given an oral antibiotic to help prevent infection. You can resume exercise after 2 weeks.
It may take several months for your wound to completely heal. Continue wound care until it is completely healed.
Sleep with extra pillows to keep your head elevated. Avoid bending your head forward below the level of your heart for the first 3 days.
If the wound is near your eye, you may get a black eye and/or bruising below the surgical site. This should improve over a period of weeks. Your eye may also become swollen shut. This is temporary and should resolve within 24-48 hours.
If the wound is on your lip, you may need to use a straw when consuming liquids. Avoid any movements that strain the sutures, such as flossing or yawning.
If you take a blood thinner, you do not need to stop taking your medication unless you were directed to do so by the doctor who prescribed the medication.
Avoid alcoholic beverages for two days. Alcohol can thin your blood, increasing your risk of bleeding.
You may be prescribed an antibiotic depending on the site or complexity of surgery. Please ensure that you have informed your doctor of any allergies to medications and provided a complete list of your current medications and supplements. Finish the entire course as prescribed unless you have side effects preventing you from doing so.
Any time the skin is cut, a scar will result. Expect the scar to look lumpy and red for a period of at least several weeks, and to continue to improve over the following 18 months.
Following any surgery where the wound was closed with sutures, you may feel small lumps underneath the skin for up to three months following your procedure. These are dissolvable sutures below the top layer that help reinforce the wound while it heals.
You may get a reaction to your sutures. This may appear as one or more one or more bumps along the surgical scar, which often look like pimples. If this happens, you can apply Vaseline to the bump(s) throughout the day as they heal. You may also schedule a wound check appointment with your doctor if you are concerned.
If the scar is raised, massaging it can help it soften and fade more quickly as it heals. One month after removing your bandages, you can apply firm pressure with clean fingertips to the scar. Move your fingertips in a circular motion for one minute at least five times per day.
You may begin to use scar creams 1 week after surgery as long as the area is no longer bleeding, draining or open. Wait until no blood or discharge is present and skin has closed over before using scar creams. Recommended scar creams include Scar-Away or Kelo-Cote.
Be sure to protect the surgical site from the sun throughout the healing process and onwards. You may begin to apply sunscreen (SPF 30 or above) to the wound after you stop using the ointment. If you are planning to use scar creams, apply the sunscreen over the scar cream. Protective clothing or an opaque bandage over the site are good options as well.
There are cosmetic procedures that can be done in the office to help improve the scar sooner. Please inquire if interested.
CALL THE OFFICE
If you notice any symptoms of infection such as spreading redness, pus, foul-smelling odor, and/or increasing pain.
If the wound becomes very itchy with increasing redness, as this could indicate an allergic reaction to the bandaging materials.
If you have bleeding that will not stop after holding pressure.