Wound Care – Closure with Non-Dissolving Sutures
Cotton swabs (Q-Tips)
1/2-inch or 1-inch medical tape (paper, plastic, or silk tape)
Non-adherent gauze pads (such as Telfa brand or equivalent)
NOTE: It is imperative to wash hands with soap and water prior to any dressing change. Only clean, fresh gauze or cotton swabs should be used to cleanse a wound. Do not use washcloths or paper towel.
Patients will be sent home with a “pressure dressing” consisting of several pieces of white gauze secured with tape. The pressure dressing should remain in place for 48 hours. Patients should avoid wetting the dressing during this time.
After 48 hours, the pressure dressing should be removed, and the patient should begin wound care. The suture line should be cleansed once daily with hydrogen peroxide, using either a clean Q-Tip or cotton gauze. The solution will bubble away loose crusts and drainage. The patient can then gently loosen these crusts with the Q-Tip and pat dry. For stubborn crusting, gauze saturated with peroxide should be placed over the wound for 10 minutes to soak and loosen the debris. If a stubborn area of crusting persists, the patient should leave it as is and proceed to the next step.
After cleansing the wound, the patient should apply a thin layer of petrolatum over the stitches. The wound should then be covered with a non-adherent gauze pad cut to the necessary size and secured with medical tape. The wound should be kept moist and covered at all times.
The patient may shower after 48 hours, but the forceful stream of the water should not hit the wound directly. During the shower, the dressing should be in place, and the daily dressing change should be performed afterward. The dressing will protect the shower water from directly striking the wound.
During the surgery, bleeding areas are cauterized to prevent post-operative bleeding. The pressure dressing over the site also helps to prevent bleeding. For 45 minutes after the surgery, the patient should apply additional firm pressure by placing one hand over the dressing. This should be performed as 10 minutes of pressure, followed by a 5-minute break. Repeating this cycle three times will complete the 45 minutes.
It is normal to notice a small amount of blood on the edges of the dressing the first day. If bleeding is persistent, firm, steady pressure should be applied over the dressing for 20 minutes. Note that if the dressing has become saturated, it should be removed and pressure should be applied with clean, dry gauze. If bleeding continues, pressure should be repeated for an additional 20 minutes. If bleeding persists at this point, the doctor should be called or the patient should go to the nearest emergency room while continuing to hold pressure on the wound. Finally, if marked swelling at the surgical site is noted, it may indicate blood accumulation (called a hematoma). The doctor should be notified immediately.
The patient should not take any medication containing aspirin (unless prescribed by a physician) or drink any alcohol for three days after surgery, as these may increase the risk of bleeding. It is permissible to take ibuprofen (such as Advil or Motrin) or naproxen (Aleve) with smaller surgical sites. Because these medications are weak blood thinners, the surgeon will tell the patient if they need to be avoided (with larger surgical sites). The patient should continue to take all other prescribed medication.
Post-operative pain is usually minimal. Plain Tylenol or Extra Strength Tylenol, two tablets every four hours, usually relieves any pain patients may have. The patient should not take more than 3,000 milligrams of Tylenol in a 24-hour period. Ibuprofen or naproxen may be taken unless told otherwise. If needed, an ice pack or bag of frozen vegetables may be applied adjacent to the dressing during the first 24 hours after surgery, alternating 10 to 20 minutes on and 10 to 20 minutes off. This will relieve swelling, help minimize bruising, and lessen pain.
There may be swelling and bruising around the wound, especially if near the eyes. The area may feel firm and swollen (but will gradually soften and return to normal appearance over time). The edges of the wound may be pink to red in color. This will lighten day by day. Slight tenderness to touch is normal.
As the patient’s surgical site heals, occasional sharp but brief pains may occur. Itching is common, but if it’s severe and associated with a rash, call the doctor’s office. Numbness may be present but resolves over several months. Not uncommonly, the absorbable stitches under the skin may cause one or more small, red pimples to appear along the incision line. In general, this is an annoyance but will not interfere with final wound healing.
- A used applicator should never be placed back into the hydrogen peroxide.
- If the wound site is near the eye, saline eyewash (such as Dacriose) may be used on an applicator to clean the corner of the eye and eyelids.
- Scissors should be cleaned with alcohol before each dressing change.
- It is a myth that wounds heal better with a scab. If a scab begins to form, soak the wound with hydrogen peroxide and gauze for 10 minutes and gently rub it away with a cotton swab.
- If pain at the site increases with time, or if the wound develops redness, warmth, swelling, or pus-like drainage, call the doctor’s office. These are signs of infection.
If you need immediate medical care, go to your nearest emergency room.
If you have any questions, call an Associated Dermatologists office.
- Do not consume alcoholic beverages at least 24 hours prior to treatment, as alcohol may thin the blood and increase the risk of bruising.
- Avoid anti-inflammatory/blood thinning medications if possible for a period of two weeks before treatment. Medications and supplements such as aspirin, Vitamin E, gingko biloba, ginseng, St. John’s Wort, Omega 3/fish oil supplements, ibuprofen, and other NSAIDS have a blood thinning effect and can increase the risk of bruising and swelling after injections. If you are on a prescription blood thinner, please DO NOT discontinue your medication without first consulting with your physician.
- Schedule your dermal filler appointment at least two weeks prior to a special event which you may be attending, such as a wedding or a vacation. Results from the dermal filler injections will take approximately four to seven days to appear. Also, bruising and swelling may be apparent in that time period.
- Discontinue Retin-A two days before and two days after treatment.
- Reschedule your appointment at least 24 hours in advance if you have a rash, cold sore, or blemish in the area.
- If you have a history of cold sores, please let the provider know. They may put you on an antiviral medication prior to treatment.
- Be sure to eat a meal and stay hydrated prior to treatment. This will decrease the chances of lightheadedness during your treatment.
- Avoid significant movement or massage of the treated area, unless instructed by the physician.
- Avoid strenuous exercise for 24 hours.
- Avoid extensive sun exposure or heat for 72 hours.
- Avoid consuming excess amounts of alcohol or salts to avoid excessive swelling.
- If you have swelling, you may apply a cool compress for 15 minutes each hour.
- If approved by your doctors, take oral Arnica and/or Bromelain to help the bruising and swelling. Start at least two days prior to injections. Topical Arnica/Vitamin K cream may also be used post-procedurally.
What to Expect:
- You may experience minimal bruising at the injection site. This will resolve shortly.
- You may experience a headache for a short period of time after treatment. This will resolve shortly.
- You can expect to have some minimal effects three to five days after treatment.
- The Botox will peak in effect 10 to 14 days after treatment.
- The effects of Botox should last four to six months.
Do’s and Don’ts:
- Do facial exercises in the area of treatment for the first hour after treatment.
- Do relax the face after the first hour.
- Do wear sunscreen.
- Don’t lie down for four hours after treatment.
- Don’t massage the injection sites.
- Don’t work out for 24 hours after the treatment.
- Don’t have a facial for the first two days.
- Don’t sit in the sun for the first two days.
- Don’t fly on the day of treatment.