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The following are post surgery instructions for patients having a piece of hardware removed from their bodies. The procedure may be performed on an outpatient basis (discharged 4-6 hours after surgery) or you may be required to stay overnight in the hospital (discharged within 24 hours after surgery), depending on your individual circumstances.  Please refer to this reference sheet, which should probably answer most of the questions you might have. If you have further questions that need immediate answering, contact us at our office.

Dressings

You have a dressing over your wound. Although it is very unlikely, you may notice some bloody spotting coming through the dressing. It is important for you to watch this area, and contact us if it continues to spread. Otherwise, any small area of spotting will dry and can be ignored until we remove the dressing.  For most simple hardware removals we allow you to remove the dressing down to the steristrips or wound on the 3-4th day after surgery.  For example with absorbable suture, if surgery was on Thursday, you may remove the dressing on Sunday or Monday.  If the wound is dry, you may shower, minimizing the amount of soaking, and leave the wound dry.  If there is drainage, apply a light sterile dressing and notify our office to arrange a wound check.

Sutures

Absorbable for small wounds:
The sutures utilized in closing any wounds will be an absorbable type, and will not need to be removed unless you are told otherwise.  The steristrips can be left on until they fall off or removed after 2 weeks.

Nonabsorbable for larger wounds:
The sutures utilized in closing the wounds are nylon suture or stainless steel staples. We will remove these around 7-10 days after surgery.

Swelling

Swelling around the surgery site is NORMAL. Reducing the swelling as much as possible will improve comfort and mobility. The following will help to reduce swelling.  For the first week when you go to bed, elevate your leg or arm. Avoid dependent position especially for leg surgery and elevate when up at least on a chair.  The ice should be replaced every 2-3 hours for the first 24 hours. Protect the skin from direct contact with the ice pack. (Not necessary to change as often during sleep hours.)  After the first 24 hours apply refreshed ice pack on the site, 3 or 4 times a day for 20-30 minutes. The ice and elevation may be helpful up to 1-2 weeks after surgery. If you feel the swelling is excessive you should call the office.

Medications

You will be provided with a prescription for a pain medication when you are ready to leave the hospital. Usually, we will prescribe hydrocodone, hydromorphone, or oxycodone. These are generic names for three different narcotic pain relievers. If you are aware of a certain pain medication that you have previously had problems with or one that you normally respond favorably to, please inform us so that we can give you the appropriate prescription. You may have the prescription prior to surgery to avoid filling it the day of surgery.

You might also be given a prescription for an anti-inflammatory medication Toradol (ketorolac) that will help lessen pain and swelling. If not, you are welcome to use an over-the-counter anti-inflammatory such as Ibuprofen (Advil, Nuprin, etc.). These come in 200-mg tablets. The usual maximum adult prescription dosage is 400-600 mg 3-4 times per day, usually taken with food. This would amount to taking 9-12 store tabs per day. The anti-inflammatory medicine can be taken on a regular basis along with the prescription pain medication, which is utilized on an as needed basis. You will find that the combination will lessen your need for the prescription pain pill. If you have a history of ulcers or of stomach irritation with aspirin or anti-inflammatory drugs, then you should avoid taking these medications. If you have high blood pressure you should check your blood pressure to be sure these medications do not cause an elevation in your pressure.  If you have kidney problems you should avoid these medications.  

Plain Tylenol is OK if you have no liver disease. Remember, the short acting pain pills often have acetaminophen (Tylenol) in them. The maximum daily dose of Tylenol if you have a normal liver is 3500-4000 mg.  If your narcotic pain medicine is not lasting long enough you can use a little more or use if less often as long as you do not overuse the maximum daily acetaminophen dose.

If you have a history of nausea with surgery we can prescribe an anti-nausea medication (Phenergan or Zofran).  Try to take this medication regularly at first and prior to taking the narcotic pain pills to allow it to be most effective.

Please try to anticipate the need for any refills on your pain medication, and contact our office early in the day the day before running out completely. I cannot provide prescription refills after business hours or on weekends.

Office Follow Up

Please call our office within a few days following surgery to schedule your first follow-up visit.  The exact timing of follow-up should be outlined after surgery.  

Complications

Most hardware removal surgery is safe and performed as an outpatient, so complications are fortunately quite rare. The worse early problem is excessive swelling or wound drainage.  If you are having increasing pain unrelieved by the pain medications, pressure, the feeling the dressing is too tight, or numbness and tingling, the dressing may be too tight.  If this is unrelieved by elevation you may loosen the dressing.  If there is no relief you should seek immediate consultation either in the emergency room or our office.  

The incidence of an infection is low after these procedures but can happen. The onset of symptoms would be approximately 5-7 days following surgery and would consist of a significant increase in pain, swelling, warmth, and redness of the wound, fever, chills or night sweats. More common, but still quite rare, would be a small superficial infection or irritation at one of the skin incisions. There can also be a very small incidence of a blood clot developing deep within your arm veins or leg veins. If you have had a previous blood clot, use estrogen, or have a family history of blood clots in the legs, arms or lungs you should probably be protected with TED hose and aspirin or a blood thinner.  If we did not start this let us know.  If we recommended aspirin for blood clot protection you should use a baby aspirin twice a day for 2 weeks or as long as the leg or arm is immobilized.  A blood clot would be characterized by a sudden onset of new pain (usually different from your surgical lower extremity pain) or tightness in the upper arm or more commonly the leg. This usually begins about 5-7 days from the day of surgery. The presence or absence of a clot can usually be determined by a simple non-invasive ultrasound test at the hospital.

If you then still have any questions or concerns please notify me, my nurse, or physician assistant.

Bryan Bomberg, MD
11/16

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