Pre and Post-Operative Instructions

Being prepared will greatly help to optimise your healing following surgery.

Before having surgery, you should carefully consider whether or not you need to:

• Take time off work.
• Have someone drive you home after surgery
• Rest for an extended period. (eg. lying down or sitting with your leg elevated)
• Organise help around the house while you rest.
• Prepare meals in advance. This prevents long periods of standing.
• Have pain relief.  (Panadol™/Avoid Aspirin and Anti-inflammatory Drugs)
• Return to the Clinic for dressing changes or for wound inspections if directed, otherwise purchase enough dressings to change at home.  We recommend Opsite Post Op dressings available at most pharmacies.
• Have further surgery later on.  ( 95% of lesions do NOT require any further surgery).

Pre Op Cleaning and Preparation

• Ensure the op site is clean and has been prepared for surgery. This may include removing hair from the op site. This is usually done by using a clipper not by shaving as shaving increases the risk of infection.
• Some of the areas of the body require extra attention regarding cleaning and these include the scalp, face, underarms, groin, and below the knees, as these are potentially higher risk areas for infection.
• You may be advised to use some antiseptic soap and/or antibiotics before your procedure.

Showering

You can use regular shampoo and face wash any time prior to surgery.

• Do NOT use any perfumes, lotions, creams, or gels prior to surgery.

Shaving

Do NOT shave the surgical area in the 24 hours prior to surgery

Clothing on day of surgery

Clothing and footwear should be clean, loose and comfortable.

• Do NOT come straight from a hot and dusty workplace – have a shower first.
• Slip-on shoes are preferred

Food/Drink

• Avoid food and drink in the 4 hours prior to surgery.
• Aim to have an empty bladder prior to surgery.

Medication

• It is important to take all medications as usual, unless otherwise directed.
• If you wish, take pain killers/analgesia an hour or so before surgery
• Antibiotics are not normally required in skin surgery.  Antibiotics are only given for those areas considered high risk for infection such as ear, nose, lip, groin and lower leg.
• Have adequate pain relief prepared for after your procedure. Discuss this with your doctor, as different levels of analgesia will be required depending on the site and the nature of the surgery you are having.

Minor bleeding occurs in almost all cases of surgery.  Continue all prescribed blood thinners unless otherwise directed.  These include: Aspirin/Warfarin/Plavix/Iscover/Asasantin.

Please note: Aspirin, Nurofen, fish oils, vitamin E, ginkgo, and turmeric all increase the risk of bruising. Also, Aspirin takes 7 to 10 days to get out of the system to reduce bruising and bleeding problems.

Alcohol

Alcohol is an immunosuppressant, and it increases the risk of infection, and it also reduces the healing rate of wounds. Post-operation, alcohol can also cause considerable bleeding, and must be avoided, particularly for the first 24 hours after an operation.

Smoking

Try to stop before Surgery

• Smoking is a risk factor for Skin Cancer
• Smoking has NO beneficial effects on your health or wellbeing

Common Complications

With all procedures, there are potential complications. The complication list includes:

• Infection
• Bleeding or bruising
• Scarring
• Nerve damage

Infection Symptoms

Some people get infections after operations and the classic symptoms include:

• Redness
• Soreness
• Discharge from the wound

Bleeding

Bleeding is also a consideration post-operation, and this can be reduced by:

• Adequate rest and elevation immediately after the operation.
• Avoiding alcohol in the first 24 hours post-procedure.

However, if some bleeding does occur, it’s important not to panic. Reduce bleeding by:

• Putting pressure on the area
• Elevate
• Ice

In 90% of cases, the bleeding will settle with the above simple measures. However, if this does not occur and you have considerable bleeding, either ring 000 for ambulance support, or ring your doctor immediately to seek advice.

High-Risk Situations for Bleeding

• Having an operation while taking blood thinners.
• Operating on an area where there’s a lot of blood vessels, particularly the face, scalp, and fingers. Therefore, it’s important to understand if you have an operation in these areas you will need to take caution with your activities.

Delayed Bleed

Some procedures will bleed several hours after the surgery when the anaesthetic wears off, and this is called a delayed bleed. The reason for this is when we use an anaesthetic, it constricts the blood vessels, and when the anaesthetic wears off, sometimes these blood vessels dilate and unblock the cautery plug that has been placed on it during the operation, and this may cause some bleeding. If this occurs after your surgery, do the following:

• Pressure
• Elevation
• Rest is important

It is important to discuss this with your doctor.

Scar Tissue

With any procedure on the skin, there is potential for scar tissue formation. However, there are some high risk areas of the body where scar tissue may form. This predominantly occurs:

• In the t-shirt area of the body, as shown, particularly the front and back of individuals
• The face, particularly around the earlobes or behind the ears.

Scar tissue formation is unpredictable. A perfect surgery can occur in this area, but unfortunately, several weeks to months after the procedure, a thickened scar may occur. This is often called a hypertrophic or a keloid scar. The characteristics of an abnormal scar such as a hypertrophic scar or a keloid scar would be either:

• Itchiness
• Tenderness
• Redness
• Thickening over the operation site.

There are several things that increase the risk of abnormal scarring, and they include:

• Infection
• Haemorrhage
• Trauma to the wound after the surgery.

Some people have a genetic tendency to develop either keloid or thickened scars, and it’s important to ask your family members whether they have scars that have thickened during procedures, or if you have had procedures where you’ve had thickened scars in the past, as this, unfortunately, may be a feature of your healing process.

Unusual keloid scars can commonly form on the face, usually behind the ears or on the earlobes, particularly in women who have had ear piercings.

Nerve Damage

Some surgeries do have specific potential complications, and this is particularly on the face or neck. There are some sites on the face, as shown, where there is increased risk of nerve damage if you have a surgery in these particular areas. These include the temporal branch of the facial nerve, and also the mandibular branch of the facial nerve. Your surgeon will be well aware of these areas and will do their best to avoid doing damage to these areas. However, if a tumour is involving the nerves, then damage may be unavoidable. The risk of nerve damage is uncommon.

Tendon and Ligament Damage

There also may be potential for tendon and ligament damage in surgeries on the hand, but this is also considerably rare, and with most skin surgeries, deep incisions into those areas are not usually necessary.

If you have any concerns about any complications before your procedure, please do not hesitate to contact your doctor and ask for advice.