This pamphlet is written to answer some of the questions that you may have after your surgery is completed. Click below to find the information most applicable to your post-operative needs.
- Wound care - sutured and unsutured wounds
- What to avoid
- Signs to be concerned about
- Frequently asked questions
- Wound care - skin grafts
- Wound care - skin flaps
- Contact us
The first question always concerns wound care. After completing your surgery we will thoroughly explain exactly what type of wound care you should give your wound every day. An unsutured wound should be cleansed with half-strength hydrogen peroxide daily using a Q-tip. The wound should be dried with a Q-tip or gauze. After the wound is dry, antibiotic ointment should be applied sparingly. In certain wounds, we may request that you place xeroform gauze over the antibiotic ointment. This, however, will be individualized. Following the application of the antibiotic ointment, a bandage should be applied over the wound.
For those wounds that are sutured, no covering will be necessary after the first 24 hours. We prefer that you continue to clean it daily with a dry Q-tip and apply the antibiotic ointment. Sutured wounds must be kept absolutely dry for 72 hours, and peroxide should not be applied.
- Severe swelling
- Marked inflammation or redness
- Development of pus
- Uncontrollable bleeding
- Will I have pain after surgery?
Most patients have little or no discomfort following surgery. If you have some pain, we recommend that you take two tablets of Tylenol every four hours. Avoid aspirin-containing compounds or NSAID (drugs such as ibuprofen, Naprosyn, Advil or Aleve) as they may produce bleeding. If you do have more severe pain, we will give you a prescription for the pain medicines that you will need to fill at your local pharmacy. If your pain continues, you should contact us.
- What about bleeding after surgery?
Most wounds will ooze a small amount of blood in the first few days. Rarely does significant bleeding occur following surgery. If it does happen, lie down and place steady firm pressure over the bandage as close as possible to the area from which the blood is oozing. Apply firm, continuous pressure for 20 minutes. Do not lift the bandage to check on the bleeding. If the bleeding occurs in an extremity (arm or leg), elevate the extremity above the heart and apply pressure. If the bleeding persists after 20 minutes of steady pressure, you should contact Dr. Patel. If you are unable to reach us, go to the nearest emergency room.
- What are other possible complications following surgery?
All wounds will develop small surrounding halos of redness, which will disappear gradually. Severe itching and extensive redness may indicate a reaction to the adhesive tape or the ointment that you are using. You should call the office of this develops. Swelling is common following surgery, particularly when it is performed around the eyes. All wounds show a moderate amount of swelling, but usually it is not a problem. We usually insist on frequent dressing changes since all wounds will drain. If you should develop severe swelling, marked redness or purulent drainage from the wound, you should contact the office. Infrequently, wounds will become infected and it will be necessary to place the patient on an oral antibiotic.
- Will I have a terrible scar following my surgery?
Usually the surgery wounds heal very nicely. Frequently we are able to close the wounds with sutures, which usually give excellent cosmetic results. Other wounds are allowed to heal on their own. These too, usually heal very nicely over a period of several weeks to a couple of months. Infrequently, wounds will require plastic surgery to obtain an optimal cosmetic result. Each case is highly individualized, depending on the location of the tumor, its size and that particular patient’s preference. Smoking, diabetes and certain drugs slow wound healing and may interfere with the final result. Wounds remodel themselves continuously. The most significant change in wounds occurs in the first six to 12 months.
- What happens if the wound is closed immediately?
If the wound is closed with sutures, it will be important that you place antibiotic ointment over the suture line. Do not get the wound wet! After the first 24-48 hours, the bandage may be taken off the wound. If purulent or foul-smelling drainage oozes from the wound, you should call our office. Most wounds can get wet after 72 hours. Stopping smoking or a significant decrease in smoking will improve results.
- If the wound is allowed to heal by itself, what is the procedure?
If the wound is allowed to heal by itself (granulate) the dressing must be changed every day until the wound is completely healed. All wounds normally drain and dressings are changed daily to rid the wound of such drainage and to keep the area clean. Wound care instructions will be given to you by the nurse at the end of the surgery and are repeated at the beginning of this pamphlet. Open wounds may get wet after 24-48 hours.
- How long will it take for a wound to heal itself?
Wounds that are allowed to granulate will usually heal in four to eight weeks. When healing is advanced, you may stop the daily dressings. Wounds that are closed by sutures are healed by the time the sutures are removed at one to two weeks. It is important to note, however, that these wounds are still weak and could be separated if placed under any tension. All wounds will remain red and somewhat lumpy for two to 12 months following surgery.
- What happens after the wound is healed?
You may experience a sensation of tightness (or drawing) as the wound heals, but this is normal. Some patients will develop periodic shooting sensations in the wound, which also stop with time. After several months, you will feel this less and less. Frequently, tumors involve nerves and it may take up to a year or two before feeling returns to normal or near normal. Sometimes the area stays numb permanently. Only time will tell.
- Once the wound is healed, how often must I return for a follow-up?
A follow up period of observation for at least five years is essential after the wound has healed. Our practice is to have patients return to their referring physicians for yearly visits. Patients initially seen in our office will return here. Should there be any recurrence of the skin cancer after the surgery, it may be detected at once and treated. Experience has shown that if there is a recurrence, it usually will be within two years following surgery. Studies have shown that once you develop a skin cancer, there is a significant possibility that you will develop others in years ahead. We recommend that you be seen at least once a year for the rest of your life by a dermatologist so that he/she may determine whether you have developed any new skin cancers. Also, should you notice any suspicious areas on your skin, it is best to check with your referring physician to see if a biopsy is necessary.
- Must I avoid the sun?
No, not entirely. We do not think that sunshine will be harmful to you as long as you provide yourself with adequate protection, avoid sun burning and use discretion. As mentioned earlier, sunlight is the main contributing factor in the development of skin cancers and patients who have developed one skin cancer often will develop more at a later time. Therefore, in the future, when you go into the sun, we recommend that you liberally apply a sunscreen/sunblock with protection factor of at least 30 with zinc or titanium dioxide to all exposed areas, including the ears. Wear a broad-brimmed hat. Avoid midday sun.
Leave the dressing placed in the office on for the first 24-48 hours, unless otherwise instructed. You may remove this dressing from the grafted area by freeing both ends of the tape from the skin where it is attached and the lifting the dressing straight off the wound. Do not pull the dressing across the wound. The donor site dressing may be removed in 24 hours. This site should be treated just as the sutured wound as described earlier in the pamphlet. For split thickness grafts, those with open wounds, that care is individualized according to site and wound. Generally these open wounds are treated similarly to the unsutured wound instructions.
After the initial dressing is removed from the graft site, use a clean, dry cotton-tipped applicator to gently clean around the spongy bolster that has been sewn in place. DO NOT GO UP UNDER THE BOLSTER. With another clean, dry cotton-tipped applicator, apply a light coating of Polysporin ointment around the bolster and apply ointment once a day until you return to have the bolster removed.
It is important to protect the graft site from being hit, rubbed, scratched or anything that might cause the graft to become dislodged. Therefore, a loose band-aid or Telfa strip should remain across the area at all times. Change daily or if the covering becomes soiled or damp.
Keep the graft wound absolutely dry until you are seen for follow up and given instructions as to when you may get the area wet. The donor site may get wet usually in 48 to 72 hours. Avoid smoking for seven to 20 days. Do not drink alcohol for 24 hours.
Sleep with your head elevated at least 30 degrees at night for three nights. During the two to three days after surgery, try to sit in a recliner and keep as still as is reasonably possible. Avoid bending over, any vigorous activity, and when going to the bathroom avoid straining for at least one week following surgery.
Apply antibiotic ointment to the donor site sparingly one to two times per day. This area may be left open or covered after the first 24 hours.
Contact us if you should develop redness around either the donor site where the skin was taken or around the site where the skin graft was placed, or if you develop any marked tenderness or drainage from either area.
You should be seen in the office in five to seven days following the skin graft.
Contact us immediately if there is any bleeding from under the graft.
Grafts frequently do not look good initially. They frequently are scabby, swollen and discolored after the stent is removed. Grafts will remodel themselves significantly over the first four to six months. Sometimes the grafts become swollen or puffy after the first few weeks. If this occurs it will usually settle out on its own. Sometimes a second procedure such as sanding the edges or injecting the graft is necessary.
Leave the dressing which was placed in the office on for 24 hours. When the dressing is ready to be removed, remove the tape, as it is attached to the skin from both ends, then lift the dressing directly from the wound.
If there is a large amount of crusting or dried blood in the area, you may remove that very gently with a little ointment. Do not force any crust which does not clean off easily. Do not apply any pressure or scrub around the wound.
Apply a thin coat of antibiotic ointment to the wound daily. Before applying this, clean the previous ointment with a dry Q-tip.
After surgery, go home and sit with your feet propped up and your head elevated in a recliner, if possible. Try to remain as inactive as possible. Avoid bending over or any strenuous activity. Do not strain when going to the bathroom. The first 48 to 72 hours are the most critical time after surgery. Be especially careful with your activity in this time.
That night when going to bed, sleep with your head elevated on several pillows for three nights. Continue to limit your activity for one to two weeks following surgery. Avoid smoking for 7-10 days and do not drink alcohol for 24 hours following surgery.
If the skin of the flap or around the flap should start to become dark blue or black, PLEASE CONTACT US.
If you develop any marked redness, tenderness, purulent drainage or bleeding from the wound, PLEASE CONTACT US.
Do not get the wound wet for three days.
After the initial dressing is removed, no other dressing should be necessary. If you wish to cover the area, you may do so with a very light gauze dressing taped in place with a minimal amount of tape. Again, if this is done, be sure you free both ends of the tape before taking the dressing off.
DO NOT PULL THE TAPE OR DRESSING ACROSS THE WOUND!
Flaps are initially swollen and discolored. It takes several months for them to settle and blend with the surrounding skin. It is sometimes necessary to do a second “touch-up” procedure to optimize the final functional and cosmetic result.
Advanced Dermatology & Skin Cancer Associates
7658 Poplar Pike
Germantown, TN 38138
Office Hours: Monday - Friday 8:15 a.m. - 4:30 p.m.
An answering service is also available for any emergency needs or concerns should they arise after hours.