Q: What did Dr. Cowan tell me about wound care?
A: In every case, your registered nurse will review all of the required wound care instructions with you at the end of your surgery and often request that a friend or family member also be in attendance to hear as well. You have also signed a carbon copy of the care instructions to confirm that you heard them, and you have a copy at home. Read over the instructions again. If there is anything that you do not understand, contact the office during working hours or the 24-hour on call service if the problem cannot wait until morning. Remember the after-hours on-call service is only for medical EMERGENCY like uncontrolled bleeding.
Q: How long do I leave the stitches in?
A: Facial stitches should remain in place no longer than 5 days in most cases. Dr. Cowan will advise if he wishes the stitches to remain in place longer. Stitches on the body, neck and scalp may remain longer. As our office is only open 7 days a week, this may mean that you have to arrange to have stitches removed by your family physician or at a walk-in clinic, depending on when your surgery is arranged.
Q: Who removes my stitches?
A: Nurses remove all stitches at the Skin Care Centre, but you may have stitches removed by your family physician or at a local walk-in clinic if you live remote from our centre (we don’t consider crossing the 1st or 2nd narrows bridges remote). If you live in the greater Vancouver area you will be requested to return for stitch removal and simultaneous assessment of the operative site.
A: In every case, your registered nurse will review all of the required wound care instructions with you at the end of your surgery and often request that a friend or family member also be in attendance to hear as well. You have also signed a carbon copy of the care instructions to confirm that you heard them, and you have a copy at home. Read over the instructions again. If there is anything that you do not understand, contact the office during working hours or the 24-hour on call service if the problem cannot wait until morning. Remember the after-hours on-call service is only for medical EMERGENCY like uncontrolled bleeding.
Q: How long do I leave the stitches in?
A: Facial stitches should remain in place no longer than 5 days in most cases. Dr. Cowan will advise if he wishes the stitches to remain in place longer. Stitches on the body, neck and scalp may remain longer. As our office is only open 7 days a week, this may mean that you have to arrange to have stitches removed by your family physician or at a walk-in clinic, depending on when your surgery is arranged.
Q: Who removes my stitches?
A: Nurses remove all stitches at the Skin Care Centre, but you may have stitches removed by your family physician or at a local walk-in clinic if you live remote from our centre (we don’t consider crossing the 1st or 2nd narrows bridges remote). If you live in the greater Vancouver area you will be requested to return for stitch removal and simultaneous assessment of the operative site.
Q: Should my operative site leek fluid?
A: Yes! Clear, red tinged “Cool-Aid like” fluid or small amounts of bleeding will weep from your incisions over the first 2-4 days. Your wound bed leaks a clear fluid called lymph that mixes with a very small amount of blood to look like red Cool-Aid. This resolves over days. Dr. Cowan does not cauterize the edge of the skin to give a better scar in time but early on small amounts of bleeding from the skin edge may shock you. Simply apply dressings if bleeding persists. Brisk flowing bleeding that does not respond to 15 minutes of direct persistent pressure (without looking at the wound) should be reported to the surgeon on call.
Q: Do I have an infection?
A: A certain amount of redness around your surgical site is expected after surgery. The tissues have been manipulated and don’t like it. A true surgical infection has a number of features: increasing redness that continues to extend beyond the wound; increasing temperature of the wound; the expression of creamy white, milk-like puss; and the possible association of a fever (temperature ≥ 38.5°C). If you have this constellation of symptoms, contact the staff immediately.
Q: I am starting to get very swollen 3-5 days after my surgery. Is this normal?
A: All surgical sites begin to peak swell significantly at 3-5 days after surgery. The swelling starts to resorb at 7 days after the operation but may persist in part for many weeks. Icing the surgical site if approved by Dr. Cowan or the nurse may reduce the swelling, as can sleeping with the affected area raised above the level of your heart.
Q: When can I start exercising?
A: Dr. Cowan will insist that all patients avoid exercises that raise the heart rate for the first week after surgery. During the second week, simple exercise can be resumed that does not stretch the surgical site (i.e. exercise bike use if the surgery was on the cheek). If general exercise will stretch the surgery site (i.e. Bench press after chest surgery or running after surgery on the legs) this form of exercise must be avoided for 6-8 weeks to allow the surgical wound to gain sufficient strength. Disregarding these restrictions will likely result in abnormal and disfiguring stretching of your scars. In some cases where exercise is commenced within the first 2 weeks, the wound can be stretched and the wound break-open. If this occurs, Dr. Cowan will likely have you manage the wound open due to risk of infection with daily ointment. A scar revision may be contemplated at a much later date.
Q: Should my operative site leek fluid?
A: Yes! Clear, red tinged “Cool-Aid like” fluid or small amounts of bleeding will weep from your incisions over the first 2-4 days. Your wound bed leaks a clear fluid called lymph that mixes with a very small amount of blood to look like red Cool-Aid. This resolves over days. Dr. Cowan does not cauterize the edge of the skin to give a better scar in time but early on small amounts of bleeding from the skin edge may shock you. Simply apply dressings if bleeding persists. Brisk flowing bleeding that does not respond to 15 minutes of direct persistent pressure (without looking at the wound) should be reported to the surgeon on call.
Q: Do I have an infection?
A: A certain amount of redness around your surgical site is expected after surgery. The tissues have been manipulated and don’t like it. A true surgical infection has a number of features: increasing redness that continues to extend beyond the wound; increasing temperature of the wound; the expression of creamy white, milk-like puss; and the possible association of a fever (temperature ≥ 38.5°C). If you have this constellation of symptoms, contact the staff immediately.
Q: I am starting to get very swollen 3-5 days after my surgery. Is this normal?
A: All surgical sites begin to peak swell significantly at 3-5 days after surgery. The swelling starts to resorb at 7 days after the operation but may persist in part for many weeks. Icing the surgical site if approved by Dr. Cowan or the nurse may reduce the swelling, as can sleeping with the affected area raised above the level of your heart.
Q: When can I start exercising?
A: Dr. Cowan will insist that all patients avoid exercises that raise the heart rate for the first week after surgery. During the second week, simple exercise can be resumed that does not stretch the surgical site (i.e. exercise bike use if the surgery was on the cheek). If general exercise will stretch the surgery site (i.e. Bench press after chest surgery or running after surgery on the legs) this form of exercise must be avoided for 6-8 weeks to allow the surgical wound to gain sufficient strength. Disregarding these restrictions will likely result in abnormal and disfiguring stretching of your scars. In some cases where exercise is commenced within the first 2 weeks, the wound can be stretched and the wound break-open. If this occurs, Dr. Cowan will likely have you manage the wound open due to risk of infection with daily ointment. A scar revision may be contemplated at a much later date.
Q: What is Dr. Cowan's preferred topical ointment (post-op)?
A: Dr. Cowan prefers Bactroban® or Fucidin® ointments rather than Polysporin® which has a higher reactivity in some patients. If you already have Polysporin and have used it successfully in the past, you are free to use it again so you do not have to purchase additional ointment.
Q: When do I stop using the ointment?
A: Stop using topical ointment one week after your stitches have been removed, unless you have a skin graft reconstruction. When you have a graft, you need to apply ointment all over the graft and the surrounding incision for at least 4 weeks post-surgery. If the graft dries out it dies. After 4 weeks you can stop the topical ointment if the graft has healed well. If there are areas of the graft that are slow to heal, continue using ointment and confirm with the nursing staff.
Q: Do I need to massage my surgery site?
A: Dr. Cowan often requests that you massage the scars on your facial surgery sites starting no earlier than 3 weeks after your surgery. This was discussed by the nurse removing your stitches and will be marked on the post-op care scar care form you received when your stitches were removed. In cases where Dr. Cowan does not want you to massage a scar, this will be indicated in the check box on the form.