Post-op care for excision

Date of procedure: ＿＿＿＿＿＿

What you must do

  • Take it easy and not get sweaty until all dressings have been removed.

  • ＿＿＿ days after the procedure: Remove the outer pressure bandage/dressing. If there is a water-resistant film you may shower over the site but avoid submersion.

  • ＿＿＿ days after the procedure: Remove all remaining inner dressings. You may now get the site wet.

  • Prophylactic antibiotics required: yes / no

  • Routine review required: yes / no

Once all dressings are removed, to support the skin and prevent scar growth you may place Micropore tape over the scar. Change it about every 2 weeks. It can get wet.

What you must look out for

There are really only two common immediate post-op complications to look out for: infection and bleeding.

  • Bleeding can happen after any surgery, no matter how minor, but happens most often in patients who are on blood-thinning medications, especially when the surgery is on a very vascular site, such as on the face. The main purpose of the pressure bandage/dressing is to prevent this from happening. Unfortunately it is difficult or impossible to place a dressing that gives enough pressure on some parts of the body, such as curved or soft parts of the face. If you have blood showing through the pressure dressing then you should call the clinic for advice. You may need it redressed. Failing to redress the wound may lead to complications such as haematoma and infection.

  • Infection is the most common post-surgical complication, and can happen after any surgery, no matter how minor, but there are several factors that increase the risk (listed below). The most important thing you can do to reduce the infection risk is to keep the site dry, including not sweating. Once the skin at the wound has sealed you may get the site wet, as bacteria will no longer be able to enter the wound. If you have signs of infection (listed below), contact the clinic immediately for advice. Some sites get infected so commonly (e.g. below the knee) that prophylactic antibiotics are routinely prescribed.

Things you may notice, but are expected

These things generally aren’t a problem, but can be surprising to some people.

  • Swelling is very common following skin surgery, especially around the eyes, lips, hands and feet. Swelling tends to be worse with increasing patient age. It is annoying, but not necessarily a problem. It usually resolves within a week.
  • Bruising is very common following skin surgery. It tends to be worse with increasing patient age, and especially patients on blood thinners. On the face it tends to cause a “black eye”. The bruise will slowly track under the skin wherever gravity takes it. It could be caused by bleeding into the skin from a small blood vessel or oozing of blood from capillaries. It is not generally indicative of a problem, and will fade over a few weeks.
  • Loss of sensation of skin around the wound is very common, especially following facial surgery and flap repairs. It can feel strange, but is not a major problem. It generally improves over time (sometimes months to years).
  • Scarring occurs with all skin surgery. Usually scars fade over time and become barely visible. On some parts of the body, such as the back, chest and shoulders, scars often become thickened. If this is happening to your scars please book a review to discuss possible solutions, which may include steroid injections into the scar.

If you have any concerns or questions, please contact the clinic. If a receptionist or nurse is unable to help you then a message will be passed on to Dr Leneham to give you a call, which he is happy to do even on his days off, if possible.

If you would like an in-person review, for example, to assess for suspected infection, please let the receptionist know. Dr Leneham may be able to see you in his lunch break if he has no other available slots. If he is not in the clinic that day you may be offered to see another doctor, or to have a message passed along to Dr Leneham.

Signs of infection

  • Tenderness. The wound becomes more sore than the day before. This generally becomes noticeable around day 3. It is usually the first sign of infection.

  • Redness extending more than 5mm from the wound. You generally won’t notice this for a while due to having the dressing in place.

  • Pus. You generally won’t notice this for a while due to having the dressing in place.

Factors that increase infection risk include: hot/humid weather, older patient, frailty, diabetes, smoking, immunosuppression, some medications, length and complexity of surgery, and body site. You can reduce the risk imposed by diabetes by keeping your BSL well-controlled, and reduce the risk from smoking by not doing it.