PRE- AND POST-OPERATIVE INSTRUCTIONS
Pre-Operative Photographs of Biopsy Sites
In most cases, it is relatively easy for us to determine the location of your biopsy site. However, occasionally, our patients do not remember where the biopsy was performed and the scar is difficult for us to find. In these cases, we recommend that our patients take photographs of their biopsy site to make locating the proper operative site easier on the day of surgery. You may take a photograph of the region with a regular camera, digital camera, or even a cell phone camera. Please let us know if you have any questions about the best way to take the photograph. Alternatively, if you would like us to take a photograph for you, let us know. We would be happy to schedule a time for you to stop by the office so that one of our staff members can take your surgical site photograph.
Please plan to avoid heavy lifting, exercise, or strenuous activity for 7-10 days after surgery as this may inhibit healing, contribute to poor scar formation, or cause bleeding. This includes working out and mowing the lawn!
It is a good idea to have some wound care materials at home, just in case your wound bleeds. Please obtain some petrolatum/Vaseline, gauze, tape, bandages, and an ace bandage. We will instruct you on how to use these items.
General Wound Care Instructions
1. Reducing the risk of bleeding
- Keep the wound elevated. If your wound is on the head, avoid bending over.
- Avoid vigorous activity, especially heavy lifting or aerobics.
- Avoid aspirin, ibuprofen, motrin, alleve, herbal medications, vitamins, and other non-narcotic pain relievers for 24-48 hours after surgery, as these may cause bleeding.
- Avoid alcohol, even beer or wine, for two days after surgery.
- Ice wound on top of bandage frequently up to every hour for 5-10 minutes as tolerated for 24-48 hours after surgery
2. Managing bleeding
- Some bruising around the wound is normal, especially when working near or above the eyes.
- Slight oozing from the wound is OK, but if the dressing becomes wet and/or soaked: TAKE THE BANDAGE OFF and clean the wound with gauze and tap water.
- Next, locate the sources of bleeding, then apply firm and constant pressure directly to the bleeding points using a gauze pad or washcloth for 20 minutes. The pressure must be continuous for 20 minutes; no peeking to see if it has stopped. After this pressure, apply an ice pack for 5-7 minutes on top of the gauze.
- Next, apply a strong compression bandage with wrap, like gauze, and tape with an ace bandage. This can be applied to a wound on any part of the body as tightly as tolerated to control the bleeding.
3. Managing your pain
- Keep open wounds covered at all times.
- Minimize physical activity and keep the surgical site elevated.
- Take Tylenol™ or generic acetaminophen, 2 extra strength or three regular, every six hours.
- If that does not help, you can take ibuprofen 200mg, up to 4 pills (800mg total) every 8 hours. It is best if you can wait 24 hours prior to starting ibuprofen, as it may make you bleed, but in some cases the pain may be too severe to wait.
- If taking both acetaminophen and ibuprofen, please alternate these medications every 4-6 hours. Do not take them at the same time.
4. Keep wound elevated whenever possible:
Arm or Leg surgery: during the day keep the extremity elevated and wrapped with a compression bandage like an ace wrap or compression stocking.
Face or Scalp surgery: sleep with head elevated on a few pillows.
5. Redness and Swelling of surrounding skin is NORMAL and will get worse over the next 2-3 days and then gradually improve in a week to ten days
For surgery near or above your eye level (i.e. upper nose, forehead or scalp), you may experience “black eyes,” or swollen eye lids. This is normal.
Gravity will generally cause swelling and “black -and-blue” to appear lower than the surgical site. This is normal and expected after surgery.
- Ice packs will minimize bleeding and/or swelling. Apply a bag of ice or frozen veggies over the bandage for 7-10 minutes every hour as needed 24 hrs after surgery. If wound is near the eye, only apply ice packs for 2-3 minutes at a time as tolerated. If swelling is still present after 24 hours, ice packs can be continued in this manner for another 24 hours.
6. Avoid heavy lifting, exercise, or strenuous activity for 7-10 days after surgery as this may inhibit healing, contribute to poor scar formation, or cause bleeding.
7. Occasionally a topical hemostatic (anti-bleeding) foam or glue is used on the surgical site to help minimize bleeding. Allow this to remain in place on the surgical site as it will dissolve on its own over time. There is no need to peel it off or remove it when washing.
8. If an itchy red rash forms under the bandage, either the ointment or the adhesive on the bandage is irritating the skin. Switch to plain petrolatum (100% pure white petrolatum) and use a compression bandage to minimize adhesives contacting the skin.
9. Call us if:
- Bleeding does not stop after 20-30 minutes of CONSTANT, DIRECT pressure;
- If your wound was closed with stitches and you notice the rapid development of swelling and bruising and you feel a pool of blood under the skin (a hematoma);
- pain does not respond to Extra Strength Tylenol™ or ibuprofen.
- a stitched wound pulls open, becomes severely painful, very swollen, tender, or leaks pus
- an itchy red rash or blisters develop around the wound.
10. A Note Regarding SCABS
- Scabs form on wounds as a normal part of the healing process.
- However, wound care healing studies have shown that a BETTER COSMETIC OUTCOME is achieved when scabs are NOT formed. We prevent scabs with regular ointment application and daily thorough wound cleaning. When cleaning your wound, please remove all dried Vaseline. If a wound is open (not stitched), bandages over the ointment help even more in achieving the best cosmetic outcome.
Long-Term Wound Care Instructions
TIPS FOR ACHIEVING THE BEST POSSIBLE RESULTS FOR YOUR SCAR
•Sun Avoidance / Sun Protection. Sunscreen can be applied to directly to the surgical site 2 weeks after surgery. Until then, it is important to avoid direct sun exposure to the surgical site.
•Massage the scar. Using firm pressure, massage the scar with circular motions of your fingers. This will help to soften and flatten the scar. This can be done for 2 minutes, 2 times per day, for 2-3 months starting 2 weeks after your surgery. The firmness of the massage depends on what you can tolerate without rubbing the skin raw.
SCAR MINIMIZING PRODUCTS
• Scar creams are not medically proven to work, but some of our patients have had good experiences with topical products such as Biocorneum SPF 30, Vitamin E Oil, Scar Guard Liquid Repair, Kelo-cote, Mederma, Silicone sheets (Mepitac, Scar Away, Retouch), or Bio Oil. These products are available at local drug stores or on Amazon.com.
•Make-Up. After the stitches have been removed, make-up can be applied on your scar. For skin grafts, please wait 2 weeks AFTER the stitches have been removed to start make-up use. Some recommended brands include: DermaBlend Professional Cover Cream SPF 30 available at Macy’s, Ulta, and online. If the redness around your scar is concerning, consider make-up with a green base which can help mute out the red color.