A guide to looking after your wound
Looking after your wound begins immediately after surgery and continues for a period of at least 3 months.
Swelling must at all-times be kept to a minimum. This is especially important in the first two weeks. This can be done by means of regular ice pack application as well as elevation of the affected limb. If swelling persists, then the swollen skin edges will pull on the stitches which will constrict and prevent a good blood flow which limits oxygenation and healing.
Another factor which limits blood flow is smoking. Smoking is absolutely not allowed. There are many surgeons who refused to operate on peripheral areas such as the feet because the wounds do not heal. Smoking also interferes with the healing of bone and may in fact cause a fracture is not to unite.
Blood flow and oxygenation is the secret to quick and uncomplicated wound healing. This is another reason why diabetic patients may have wound healing problems with increased rates of infection. This is because uncontrolled diabetes results in closure of the small capillary blood vessels responsible for carrying oxygenated blood to individual cells.
In order for wounds to unite the body as to produce a tremendous amount of new proteins which are used as building blocks to repair all damaged tissue. In order to produce these proteins we require extra energy and basic building materials. I recommend that all patients take multivitamins and increase their protein intake for the first month following surgery.
When stitching my wounds, I do not used staples or external sutures except for very specific circumstances. In most cases the stitches are beneath the skin and absorbable. All my wounds will also have special skin tape (proxy strips) applied, which should help keep the tension off the actual wound and promote minimal scar formation. The wound is also initially sealed with skin glue. Dressings applied to the wound are all waterproof enough to allow showering only. All wounds require dressings for up to two weeks. Thereafter I recommend that one uses 24 mm wide Micropore or paper tape over the wound lengthwise and this should be reapplied every second or third day. You may bath, shower or swim with this tape, just dry as per normal. A topical cream may be applied directly onto the tape and massaged onto the wound 2 x a day, and this will promote good healing and a less painful and swollen scar. Most plastic surgeons recommend that this type of wound treatment continue for 1 month post-surgery. We typically recommend the use of Dermastine-A cream, which requires a script. Thereafter, application of a silicone gel “Kelo-Cote Scar Gel” for 3 months twice daily will provide the best cosmetic result.
While the wound is healing it is recommended that you minimize sun exposure to prevent permanent pigmentation.