Primary Closure and Skin Flap

Your wound could be a simple straight line (primary closure) or a combination of lines (skin flap). Open the Primary Closure or Skin Flap Information PDF to download and print.

DRESSINGS

The choice of surgical procedure will also determine the type of dressing applied.

• Steri-strip dressing could be either a number of small individual strips layered horizontally over the wound, or a single piece of tape covering the length of the wound.
• A plastic, waterproof dressing may either be sprayed or placed over your wound and is designed to seal and protect the wound during the initial healing process.

IMMEDIATE WOUND CARE

• DO NOT remove the dressing as the stitch sealing the wound is attached to it.
• You may shower the next day after the surgery allowing the water to run over the dressing. Do not rub the dressing, pat dry only, to ensure the dressing remains secure.
• It is best to keep the wound clean and dry.
• Do not apply any creams or ointment to the wound unless advised to do so by your surgeon or the nurses.
• Do not under any circumstances shave over the wound areas.

WOUND CARE FOLLOWING SUTURE REMOVAL

• Treat the wound gently, the wound will remain tender for a few weeks.
• Shower normally, pat the area dry.
• One week after suture removal, begin to massage the area 2 to 3 times a day using any kind of skin moisturiser. Continue massaging for 2 to 3 months. This encourages circulation to the area, which speeds up the healing process and helps to flatten the scar. If you feel lumps in the wound these are generally the internal sutures which will dissolve over a 2 to 3 month period. The nurses will demonstrate and discuss the pressure the massage needs to have to be effective.

Skin Graft

A Skin Graft is performed when a patient does not have enough skin, or stretch in the skin, to repair the defect once the lesion has been removed. Skin must be taken from a ‘donor’ site and grafted onto the defect. This surgery is commonly performed on the nose, ear or scalp. Following your surgery you will have two wounds – the donor site where the skin was taken and the site where the lesion was removed from and the skin graft placed. Open the Skin Graft Information PDF to download and print.

DRESSINGS

The skin graft will be covered with a piece of gauze and foam, stitched on to your wound to put an even pressure on the graft to make sure it ‘takes’. Over the next few days the foam will absorb some blood, become hard and unsightly (see pic 2). Do not remove this foam. The second dressing is placed over the donor site.  If this is covered with a plastic dressing (ie. the collar bone) you can get this wet but do not remove it.

IMMEDIATE WOUND CARE

You will be given a tube of chloromycetin ointment. Please place a small amount of this ointment around the edge of the foam twice a day and half an hour before suture removal. This ointment helps to keep the foam moist, limits the risk of infection and allows easier removal. It is important to keep the foam dry until suture removal. You may clean around the edges of the foam with a damp sponge.

WOUND CARE FOLLOWING SUTURE REMOVAL

• Treat the wound gently. The graft remains fragile for 2 to 3 weeks after suture removal.
• You may shower and get the graft wet but avoid having the full shower stream directly on the graft. Do not rub the graft, pat dry only for 2 to 3 weeks.
• If you have some chloromycetin ointment left, you should continue to apply it over the graft until it runs out, then use moisturising cream daily.
• As the healing of the graft progresses the top layer of the skin will ‘scab’ over and gradually peel off. This is normal and is not a cause for concern.
• Three weeks after suture removal, begin to gently massage the graft 2 to 3 times a day using any kind of skin moisturiser. This encourages circulation to the area, which speeds up the healing process. Continue to massaging for 2 to 3 months. It is not usual for the graft to have a slightly bruised and crater like appearance. This will improve over a six to twelve month period.

Preparing for your Day Surgery

Fasting

Fasting is not required, as your procedure will be attended under Local Anaesthetic. If your surgery takes place under General Anaesthetic, Fasting may be required. See Preparing for Surgery if you have questions about what fasting may be required.

Your Wound

Our surgeon will choose the most appropriate method of repairing the area where the lesion has been removed. This may be a Primary closure, Skin flap or Skin graft.

Suture Removal

If you are having facial/ head surgery, your suture removal will be 5 to 7 days post surgery.

If you are having body surgery, your suture removal will be 10 to 14 days post surgery.

Your suture removal appointment will be given to you on the day of surgery.

Medications

There may be medications for you to cease, or to start taking, prior to your surgery. These will be explained to you by our admissions nurses. If you take warfarin, unless you have been given other directions by your doctor, our admission nurses will advise of what to do. Unless advised otherwise by your doctors, or our staff:

• Aspirin is not to be taken 1 week prior to surgery.
• Anti-inflammatory medications are not to be taken 2 days prior to surgery.

Post Surgery Pain Relief

Ensure you have suitable oral pain relief, such as paracetamol (Panadol) on hand for your return home. We do not provide pain relief for you to take home on discharge. We do not recommend aspirin, ibuprofen (Nurofen) or other non-steroidal anti-inflammatories for 2 days post surgery.

Other Preparations

• We encourage you to stop smoking for at least 5 days prior to surgery.
• Do not consume alcohol 24hrs prior to surgery.
• Prepare your home by placing old sheets and pillowcases on the bed in case of ooze or leakage.
• It is not recommended to drive following facial surgery due to possible swelling. We recommend you arrange a responsible adult to transport you home following your discharge.

What To Bring

As your stay with us will be brief, please bring only essential requirements.

• Medicare, DVA or Health Fund Card.
• Facility Fee or Excess payment option (EFTPOS, card, cheque or cash) or excess payment as advised previously.
• Wear dark coloured, loose and comfortable clothing with slip-on, flat shoes.
• Remove contact lenses and wear glasses on the day of surgery.
• If you are travelling long distances, please bring a driver, a supply of paracetamol, and pillow with you.
• Do not bring jewellery or valuables with you as no responsibility will be taken for loss or theft of these items.

After Your Day Surgery

Pain Relief

Following your day surgery you may experience mild discomfort and pain. It generally settles within 24 to 48 hours. Your pain is best relieved by an oral pain killer, such as paracetamol (Panadol). We do not recommend aspirin, ibuprofen (Nurofen) or other non-steroidal anti-inflammatories for 2 days post surgery.

Rest

It is advisable to rest quietly and not to undertake any form of physical or strenuous activity the evening of your day surgery. Please refrain from participating in any activity such as sports, housework, lifting children, or any activities that may compromise your wound healing. At the time of your suture removal, we will advise you when you may resume normal activities.

Bruising and Swelling

You can expect some bruising and swelling for the first few days following surgery.  It is not uncommon following surgery to the scalp, brow, nose and eye areas to have a lot of swelling and bruising around and under the eyes. Do not be alarmed, over the next 5 to 7 days the swelling and bruising will begin to subside and the area will soften and assume a more natural shape.

• Arnica cream (found at the pharmacy or health food stores) can help. This cream can be smoothed directly into the bruised area to help reduce the swelling and bruising normally associated with surgery.
• Ice packs applied to the face can also be quite soothing and help reduce swelling.
• Sleeping with your head elevated can reduce the swelling associated with facial surgery. Having a few extra pillows handy may prove to be beneficial.

Chloromycetin

Chloromycetin ointment is an antibiotic ointment used in all areas of the body to keep sutures moist and prevent infection.  If you have been given a tube of Chloromycetin, this needs to be applied directly onto the wound, twice a day as instructed.

Resuming Medication

If you have stopped taking any medication prior to the procedure, you will be advised on the day of surgery when you can resume these.

Wound Care and Dressings

Our surgeon will choose the most appropriate method of repairing the area where the lesion has been removed. Please find specific information for wound care below, depending on the type of wound closure and dressing you had attended during your day surgery.

• Surgical sites are vulnerable to the sun, please ensure you protect the area.
• After removal of sutures and when the wound is fully healed, you may use a sunscreen and make up.
• We recommend mineral makeups. Minerals are preservative and talc free, and allow for a natural, even coverage without irritation.
• You may experience slight numbness for three-four weeks around the incision site, which usually resolves.

Your dressings should stay intact until your removal of your sutures. Should you feel your dressing start to lift, please resecure with either micropore tape or a larger waterproof dressing (if used). These can be purchased from your nearest pharmacy.

Please call the Sole’vita Surgery on (02) 6282 1153 to talk to a nurse, if you feel that your dressing has been compromised, due to:

• Blood, or other fluid collection under the dressing
• A reaction to the dressing

Bleeding

If the wound bleeds or seeps, with clean hands and a clean tissue, apply firm pressure to the area and bleeding should stop in ten to twenty minutes. If it does not stop or you are concerned, please contact us.

If You Are Concerned/Early Warning Signs

The results of your surgery may be compromised by complications. Rapid intervention may reduce the chance of complications becoming a real issue. Please do not hesitate to contact us if:

• You are unable to cease or slow any bleeding of the wound after applying pressure to the area for twenty minutes
• You feel any heat or increasing pain developing in your wound
• You notice the wound getting red or excessively swollen

If these symptoms occur please contact us immediately. Call Sole’vita Surgery on (02) 6282 1153 Our nurses are happy to talk to you about your concerns.

Should you have any concerns outside of clinic hours, we recommend you go to your local GP, Walk In health centre or Emergency Department.

Your Financial Responsibility

Whilst every effort is made to ensure our estimates are accurate, additional costs may occur if:

• Your health fund status changes
• The treatment proposed changes or further treatment is required
• You need extra medical care
• You require pharmaceutical, pathology or radiology services prior to, during or following the procedure
• You will be fully responsible for the full cost of the hospital admission if the health fund/insurer does not cover the treatment or admission.
• Your surgeon and anaesthetist (if required) will send accounts directly to you for their services