General Surgery - Plastic surgery for skin cancer

How long will the numbness last?

Numbness can take from 4-6 hours to resolve. If you received surgery on your face, especially around lips, avoid hot food and drinks for 4 hours after surgery as it may result in burns.

Rest/Driving

Prior to the day of surgery, please ensure you have made travel arrangements, as you must not drive back home. It is important to rest for 48-72 hours for direct closures and at least 1 week for flap/graft surgery. You should be able to make an emergency stop to consider driving and do discuss with your car insurance company.

Will I have a dressing?

Most of the time, you will have a dressing, and you will be given instructions regarding care and change for your dressing.
Sometimes, the wound might require an ointment layer (Chloramphenicol eye ointment to put over the stitches).

How should I care for my wounds?

It is important to keep any dressing clean and dry until we advise you otherwise, as this will improve the healing process and reduce the chances of any infection.

If you experience any form of pain, over-the-counter pain relief should be sufficient to manage this. If you notice any discharge from the area, please inform a healthcare professional such as your GP.
 
If you receive surgery over your face, head, or extremities, it is vital to keep them raised over a couple of pillows for 4-5 days. This helps to settle any bruising or swelling. You can keep your legs over a chair, after taking a brief walk to reduce chances of swelling and issues with wound healing.

What is a skin graft or a local flap?

Sometimes after the excision of skin lesion, we cannot close it directly by putting stitches due to the size or location of the lesion. In that case, we need to reconstruct the excision defect with a skin graft or a local flap. Local flap is like a skin origami and involves rearranging the surrounding normal skin to cover the wound. Skin graft is a piece of skin borrowed from other areas of your body, and it can be full thickness or partial thickness. Your surgeon will discuss the form of reconstruction you would need and potential donor sites for a skin graft with you prior to surgery. Local flap, skin graft and its donor site usually take 2-3 weeks to heal.

What will happen to the graft/flap after surgery?

A special dressing (Tie-over dressing) will be applied to the top of the skin graft which will hold it in place and promote wound healing. To help the graft adhere to the tissues underneath, it is important not to stretch the skin or interfere with the graft or dressings in any way.

Split-thickness skin grafts are held in place with a non-adherent dressing. This can either be stitched or stapled into place. Full thickness grafts require another type of dressing which will also be stitched into place. Both apply pressure to the area to help the graft to adhere to the tissue underneath and develop blood supply.
 
After 5 - 7 days, graft/flap will be assessed in plastic dressing clinic, and you will be advised on any further measures to be taken.

If it is a split thickness skin graft, the donor site, such as thigh will also have a dressing. This will be looked at one week after your surgery and you will be advised on any further treatment if necessary. This area can be quite painful after surgery, due to exposed nerve endings but usually can be managed with over- the-counter pain relief. This area normally heals like a graze with a scar and once completely healed, skin moisturiser can help it to keep lubricated.

It is important that you avoid unnecessary walking for the first week for the graft to heal on the legs. However, it is vital to drink plenty of water and move your ankles, knees, and toes while at rest to avoid developing clots in the leg.

If you had a flap reconstruction, it may be covered with dressings. It is natural for surrounding tissue to be bruised, swollen and feel a bit numb and tighter. If you experience rapid change in colour or size, please contact us.

Can I have a bath, shower/wash hair?

For the first 48 hours, we advise to keep the area clean and dry. If the wound is not covered by dressing, then you can have a shower. If covered by a dressing, it is advised to keep the dressing dry and clean until the wound is reviewed by nurse as mentioned in your discharge letter.

If you have stitches on the scalp, wash hair as normal after 48 hours, but only use unperfumed shampoo without a conditioner. Please ensure you dry your hair straight away, using a low temperature setting on your hair dryer. Pat dry the area after you wash and avoid rubbing with a towel.

What if the wound bleeds?

This is common especially if you are on blood thinning medications. However, it can be stopped by gentle and persistent pressure with a clean cloth/tissue for 10-15 minutes. If you are on blood thinners, your surgeon should guide you after the operation for restarting them. Please note that, blood thinners do increase the risk of bleeding/oozing/blood clot formation, especially on face and scalp, hence head elevation is important. Normally the blood thinners are restarted on the next day of surgery.

Stitch removal

If you have dissolvable stitches, (white or opaque coloured) they do not need to be removed. Non dissolving stitches will be checked and removed by GP nurse as instructed on the discharge letter. If you had a reconstruction with local flap or a skin graft, you will be required to come to the Plastic Dressings clinic in 1 week for a specialist nurse to review the wound.

Will I have a scar?

Yes. All Surgical procedures leave a scar. The wound will look red, swollen and bruised in the first week which is normal healing process. The redness takes a few months to settle. Once the wound is healed, scar can be improved with gentle massaging and moisturising. Sun protection is advisable as the scars are sensitive to sunlight.

Travel or Holiday plans

Please discuss any imminent travel or holiday plans with your consulting doctor in clinic before surgery. It is advised not to plan any holidays within 3 weeks after surgery because of suture removals, dressing changes, and in the unlikely event of potential complications.

Follow up of histology results

Prior to your discharge, you will be given instructions regarding results and further follow up. Histology results are usually communicated via telephone in 4-6 weeks’ time.

When to contact us immediately?

You should contact us immediately if notice any of the following red flag signs:

• Continuous bleeding at surgical site after you have applied continuous pressure for at least 10 minutes
• Excruciating pain continues and affects basic daily life, even after you have taken over-the-counter pain relief
• The wound or dressing has a foul-smelling discharge
• Feeling unwell or spike of temperature

Who should you talk to?

For any wound or dressings related concerns, please contact the Plastic Dressings Clinic on 0161 206 5898 Monday to Friday 8am - 4pm.
You can email photographs of the wound to the plastic specialist nurses for better remote assessment by email salford.plastics.nurses@nca.nhs.uk.

Over the weekends or out of hours, please attend Salford Royal Accident & Emergency services.