The following are post-operative instructions for patients who have undergone surgery. Please refer to this reference sheet, which should probably answer most of the questions you might have. 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. You will require someone at home to assist you for the first few days.
Incision Care
You will have a dressing over your wound. Although it is very unlikely, you may notice some bloody spotting coming through the outer 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 you remove the dressings. Any wound drainage should be reported to our office. You may shower with the waterproof dressing. Some swelling, bruising and warmth are expected after surgery. If you develop increased redness, drainage, or a fever, CALL THE OFFICE. Bruising around the thigh/knee area is not uncommon. This may even extend down the leg to the shin and ankle/heel area and will resolve in over 3-4 weeks.
Sutures – small wound absorbable
The sutures utilized in closing the wound are usually an absorbable type buried under the skin, and will not need to be removed unless you are told otherwise. With a routine case these are covered with Steri-Strips which are small tapes to help keep the wound closed and are generally left on until they peel off.
Sutures – larger wound nonabsorbable
The sutures utilized in closing the wounds are nylon sutures or stainless steel staples. We will remove these around 10-14 days after surgery.
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.
Normally we will avoid using anti-inflammatory medication (i.e. ibuprofen, Advil, Aleve, etc.) as this may interfere with bone or tendon healing. If you are intolerant to most pain medications the short term use of anti-inflammatory medication is OK. In this case, you might 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.
Swelling
Swelling around the surgical site and down the leg or arm region is NORMAL. Reducing the swelling as much as possible will improve comfort and mobility. The following will help to reduce swelling. Wear the TED stockings (white) for 2-4 weeks after surgery of lower extremity 1-2 weeks for upper extremity surgery. For the first couple weeks when you go to bed, elevate your leg or arm on pillows (so that the area is above the level of your heart). Also 3 or 4 times during the day, lie flat on your back with your leg above the level of your heart (on 1-2 pillows) for 1/2 hour. 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 knee, 3 or 4 times a day for 20-30 minutes. The ice and elevation may be helpful up to 2-3 weeks after surgery. If you feel the swelling is excessive you should call the office.
Showers
with small wounds
You can remove your dressings to shower on the third day following surgery (i.e., surgery on Monday, shower on Thursday). Remove the dressings to the Steri-Strips and allow them to dry. Only be concerned if the strips appear to be moist underneath, then we will need to change them. Steri-Strips can be left on until they peel off. If there is any noticeable or persistent drainage from the incision sites or any surrounding red areas, please contact us immediately.
with larger wounds
You can remove your dressings to shower on the fifth day following surgery (i.e., surgery on Monday, shower on Saturday). Remove the dressing to the staples. You can remove the dressings including the yellow gauze. The staples can get wet but do not soak the wound. If you have a waterproof dressing you may shower at any time but it needs to be change every few days to prevent excess moisture from building up. We are concerned if there is any drainage from the wound and then apply a sterile dressing and notify our office. If the wound is dry you can leave it without a dressing unless you prefer one. If there is any noticeable or persistent drainage from the incision sites or any surrounding red areas, please contact us immediately.
with cast or splint
You will need to keep the cast or splint dry. A bath with the cast or splint kept out of the water works best. If you shower you will need to apply a plastic bag around the extremity and tape it at the top. There are excellent cast protector products (cast cover or protector) available locally at pharmacies or online from Amazon (Duro-Med). However, it is hard to keep the dressing absolutely dry and some leakage may occur. If the dressing gets a little wet allow it to dry.
Physical Therapy
Depending on the type of surgery you underwent you may be provided a prescription for formal physical therapy when you leave the hospital. All of the different therapy firms in our area are excellent so you are free to select your therapist. Please schedule your therapy to begin in the week following surgery. If you want to avoid a course of formal supervised rehab, please inform us so that we can discuss some independent home rehab options and techniques with you. Here are a few simple exercises that everyone can begin immediately.
Ankle pumps: Bend and straighten your toes frequently. Pump your ankle up and down frequently if it is not immobilized.
Office Follow-Up
If you are not given a specific follow-up appointment, please call our office within a few days following surgery to schedule your first follow-up visit for about 7-10 days after surgery. This can vary plus or minus several days depending on your schedule and ours.
Complications
The incidence of an infection deep is literally one out of thousands. On set 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 extremity, fever, chills or night sweats. A small superficial infection or irritation at one of the skin incisions can occur. 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 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 or regular aspirin twice a day for 2-4 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