Surgery

Skin surgery

The majority of patients will have been seen by one of our dermatology team prior to surgery. We endeavour to try to give you an appointment for your surgery when you are in the dermatology clinic. Sometimes this isn’t always possible and it might be that we arrange a date over the phone over the subsequent few days.

We will need to know what medications you take including aspirin and warfarin as some medications need to be stopped before surgery.
We would like you to eat and drink normally on the day of surgery.
Appointments last anything from 10 minutes through to an hour and a half depending on what is planned.
When you arrive we will introduce all members of the team and discuss what treatment options are available so that we can formulate a plan together.
We will talk to you about the risks of the operation which are mainly bruising over the few days after the operation and infection of the wound. We do everything we can to minimise these risks.
Sometimes we ask your permission to take a photo to hold on your records for further reference in the future.
After the procedure we will talk about how we will contact you with the results and whether we will need to see you again in the dermatology clinic.
Please note, it usually takes 6 – 8 weeks for histology results to be returned to us from the laboratory.
We run through how to manage the wounds. Don’t worry you don’t have to remember it as we give you an information sheet with it all written down.

If you have any questions after you have left just phone in to speak to one of our admin team who will either try to answer your query or will arrange for one of the team to speak to you as soon as is possible.

General post op advice

Please take it easy for the rest of the day.

During the next 24 hours, there may be some discomfort once the local anaesthetic has worn off. This can be relieved by taking some painkillers, such as paracetamol, but if you are worried in any way please contact us on 01900 233170 between 9am-4.30pm. Should it be out of office hours please leave a message and we will contact you the following day. If you feel you need to be seen urgently outside of office hours then please contact Cumbria Health On-Call (CHOC) on 111.

We will inform you how many days following your procedure your stitches will need removed. The practice nurse at your own GP surgery will remove them. Please contact your own practice to book this appointment as soon as possible after your procedure.

Sometimes we use dissolvable stitches and no stitches would need removed, we would then inform you how long these would take to dissolve.

Some tenderness and pain is expected after the surgery. If you notice swelling, any redness, or you have excessive pain and leakage from the wound, this may indicate a wound infection. Please contact us on TEL: 01900 233170 or contact your own GP.

If any bleeding occurs, apply continuous firm pressure with a clean pad directly on the wound for 10 minutes. Repeat as necessary. This often occurs as the local anaesthetic wears off. If the bleeding continues or is excessive, seek medical advice.

Looking after your dressings

Keep dressings clean, dry and in place until you have the stitches removed.
You may shower but keep the wound area and dressing, if any, covered or protected.
If dressings become wet or dirty, you may remove and replace them.
Alternatively if a dressing wasn’t applied use a thin layer of clean vaseline 2/3 times per day until stitches removed.

Please note, it usually takes 6 – 8 weeks for histology results to be returned to us from the laboratory.

Skin grafting wound advice

PRACTICE NURSE INFORMATION

This patient has had a full thickness skin graft. This involves two wounds: one for the donor skin site and another for the grafted skin. The sutures around the graft and the donor site need to be removed after 14 days if there is a sponge pressure dressing.

Remove the sutures securing the sponge pressure dressing, remove the sponge and the Jelonet dressing underneath (this may require soaking off). The full thickness graft is held in position by a running nylon suture around the circumference and four single nylon sutures in the 12, 3, 6 and 9 o’clock positions. The donor site has a nylon running suture. Both wounds do not require a dressing following removal of sutures.

PATIENT INFORMATION

Please make an appointment with your practice nurse to have your stitches removed in 14 days.

GENERAL WOUND ADVICE

SKIN GRAFT SITE

Keep your dressings in place until you are reviewed. You may experience mild oozing from the wound and occasionally the sponge dressing overlying the wound may irritate. Apply Vaseline to the surrounding skin if it itches and wash any surrounding skin gently with previously boiled warm water.

EXERCISE

It is important to rest for 48 hours following your operation to minimize complications. Avoid strenuous activities during this time.

PAIN

Take Paracetamol regularly if your wound is painful. If this fails to ease the pain, try taking some Ibuprofen.

BLEEDING

It is normal to expect some oozing of blood from the wound. Apply constant pressure if bleeding develops, for at least 15 minutes or until it stops, and repeat this if necessary. It should eventually stop.

INFECTION

Infection can complicate any operation and usually appears 2-7 days after the procedure. You may notice increasing pain, redness and swelling. Occasionally, pus may discharge from the wound edge. If infection occurs, see your GP for a prescription for some antibiotics or contact Cumbria Medical Services on 01900 233170 for advice.

AFTER SUTURE REMOVAL

After suture removal, wash the wound daily with previously boiled warm water, and use a thin layer of Vaseline four times daily to keep the skin moist for another 7days.

Immediate appearance: when the stitches and outer dressings are removed, the graft will be a dusky pink colour and this will improve as blood vessels grow into the skin from underneath. In the first few weeks the skin may become raised with the healing process and this will generally settle down on its own.

Late appearance: the cosmetic appearance of the graft will continue to improve for up to 18 months. The healing process may be helped by massaging a moisturiser such as E45/Vaseline into the graft once daily for 3-4 months.

IF THE SKIN GRAFT FAILS

The wound will then heal by secondary intention. In this instance it will be open and will heal from the inside out. You can look after it yourself by keeping it clean and dry, and applying a thin layer of clean Vaseline 2/3 times per day for 14 days.

Healing by secondary intention advice

Please take it easy for the rest of the day.

During the next 24 hours, there may be some discomfort once the local anaesthetic has worn off. This can be relieved by taking some painkillers, such as paracetamol, but if you are worried in any way please contact us on 01900 233170 between 9am-4.30pm. Should it be out of office hours please leave a message and we will contact you the following day. If you feel you need to be seen urgently outside of office hours then please contact Cumbria Health On-Call (CHOC) on 111.

The wound will be left to heal by secondary intention. In this instance it will be open and will heal from the inside out. If it hasn’t been dressed in clinic you can look after it yourself by keeping it clean and dry, and applying a thin layer of clean Vaseline 2/3 times per day for 14 days.

If it has been dressed in clinic please book an appointment to see your Practice Nurse twice weekly for 2 weeks to replace the dressing. You can then look after it yourself by keeping it clean and dry, and applying a thin layer of clean Vaseline 2/3 times per day until it is healed.

Some tenderness and pain is expected after the surgery. If you notice swelling, any redness, or you have excessive pain and leakage from the wound, this may indicate a wound infection. Please contact us on TEL: 01900 233170 or contact your own GP.

If any bleeding occurs, apply continuous firm pressure with a clean pad directly on the wound for 10 minutes. Repeat as necessary. This often occurs as the local anaesthetic wears off. If the bleeding continues or is excessive, seek medical advice.

Looking after your dressings

Keep dressings clean, dry and in place for 14 days.
You may shower but keep the wound area and dressing, if any, covered or protected.
If dressings become wet or dirty, you may remove and replace them.