Web Log – October 2009 – Post Op Care Rituals Explained

Belly Dancer performing at Hyde Park Festival
Belly Dancer performing at Hyde Park Festival

Some of the most common questions I am asked during consultations or pre-op evaluations are regarding post op care and activity.  Someday, I plan to add a Frequently Asked Questions page to the web site to address these concerns in detail.  The problem, however, is that every patient and every post op course is different.  As I like to say, “We do custom work.”  Accordingly, my recommendations are not written in stone.  Also, I change my mind sometimes…

First, post op activity instructions vary greatly with the operation.  All patients, however, should walk as soon and as frequently as possible after their operation to help avoid blood clot problems.  They should also use an incentive spirometer (usually provided before discharge from recovery) to expand the lungs.  This helps avoid post op fevers and pneumonia.

Strenuous activity should be limited post operation to minimize the chances of a wound opening up (dehiscence) or causing bleeding (hematoma).  I’ve seen both happen.  In operations where large spaces are opened up, fluid can collect, even after a drain has been appropriately removed. Early vigorous activity can predispose towards these troublesome fluid collections called seromas.  In the setting of breast implants or expanders, their location can be shifted before they are properly set in place.  I advise a slow return to full exercising between 4 to 6 weeks post operation.  This makes sense when you consider that healed wound strength is 50% at 6 weeks and only reaches a maximum of 80% at 6 months.  Remember, any restrictions are a short term investment in your long term result.  As always with activity, let pain be your guide.

Pain, unfortunately, is a part of surgery.  I try to help patients minimize it by using long acting local anesthetic in addition to general anesthesia during the surgery.  Binders and other support garments also tend to minimize pain.  In abdominoplasties and latissimus flaps, I also use local anesthetic pain pumps which work for about 3 days by dripping local anesthetic into the operative site.  There is no right or wrong ammount of pain medication to take.  You need what you need and will have refills appropriately.  It is the rare patient who requires prolonged medication and they are referred to a pain management specialist.  I like oxycodone as it is an effective oral narcotic with relatively little nausea side effects and the number of pills taken is not limited because it is not combined with Tylenol.  It is okay to take Tylenol and Ibuprofen or Naproxen in addition.  I like to avoid Ibuprofen and Naproxen for about 48 hours post surgery to minimize the chance of hematoma.

Return to work depends on what you do.  If you work at a desk, most lesser operations require only a few days to a week off of work.  More major abdomen, chest, or large combined operations may need 2 weeks off of work.  If you are a luggage handler at the airport ( I had one ), you might even need 6 weeks off from heavy duties.  We try to be as cooperative as possible with your return to work as we know everyone has to make a living.

Most wounds may be showered post 36 hours after an operation – I usually say the second morning after surgery.  This is because the epithelium (surface layer of skin) is sealed by that time.  Showering removes surface bacteria and just feels good.  It is okay to shower with drains.  Submerging in a bathtub should not be done for at least 2 weeks post op because static water inevitably has more bacteria.  That goes double for hot tubs.  If you have a skin graft with bolster, or are wrapped after a breast implant surgery, you should just sponge bathe around the dressing until you return for follow up.

After the wound is sealed and out of the red inflammatory phase, I recommend using silicone gel strips on wounds.  They are not magic, but have been proven to help improve scar appearance.  No one knows exactly how they work, but it is thought that they decrease surface tension on the wound and help keep it moist.  We have detailed instructions for their use and sell them at the office ( the are not generally available in stores ).  The only other product that is proven to help is Mederma.  It is available in stores, but ends up being more expensive than a reusable strip because it is an ointment that gets used up.  It is also not as effective a the silicone gel strips.  Ultimately, given good operative technique, the quality of the scar varies greatly and is mostly dependent on the individual’s skin type.  Darker types usually do not do as well.

I hope that this general overview is helpful.  As I also like to say, ” If you get 10 plastic surgeons in a room, you’ll get 11 different answers.”  That is, there are lots of right ways to do thing and the advice I give to patient’s is what I believe works best and is easiest to do.  There are definitely some wrong ways to do things, and most surgeons would agree on those.

Vendor at the Hyde Park Festival
Vendor at the Hyde Park Festival

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