POST-OPERATIVE INCISION CARE
These guidelines are to be used as a reference for the post-operative care of your incisions. Following these recommendations does not by any means guarantee that you will not have any visible scars after surgery, but have been shown to help reduce the potential of having a larger scar than normal.
INITIAL CARE (Please refer to SURGERY PACKET for more detailed initial care information)
LIGAMENT RECONSTRUCTION PATIENTS
ACL or other ligament reconstruction surgery requires arthroscopic portal incisions to be made below the patella on both sides of the patellar tendon. Additional incisions must also be made depending on the specific procedure(s), the type of graft being used as well as any additional secondary procedures that may be done along with the reconstruction, i.e., open meniscal repair, etc.
As instructed in your surgery packet you, your caregivers, or your Physical Therapist should ever remove the initial surgical dressings. These will be removed and your dressing changed on your initial post-operative office appointment. This is for your safety and for infection control purposes. Additionally, your initial post-operative surgical dressings should not get wet. Wrapping a plastic bag over your leg and either using saran wrap or tape to seal off water from penetrating the bag should be used. If they do get wet, just contact our office and you will be given specific instructions.
Most procedures that are performed arthroscopically are generally done through small portal incisions below your patella on both sides of your patellar tendon. Dr. Lowe informs the family of the patient immediately after surgery whether they can remove their initial post-operative surgical dressings. If he does allow this, the initial dressings can be removed with exception for the white steri-strips and the yellow xeroform gauze, if at all possible. Waterproof bandages can be applied over your scope portals, over the steri-strips and xeroform gauze, if possible. These waterproof bandages along with the steri-strips and xeroform gauze will be removed on your first post-operative office appointment. If additional incisions had to be made, Dr. Lowe will inform your family and your initial post-operative surgical dressings should not be removed as described in the “ACL Patients” section above.
SECOND VISIT DRESSING CHANGES
Following ACL or other ligament reconstruction surgery, your dressings will be changed again on your second post-operative office appointment. Most patients can return to normal showering after this visit, meaning no covering with plastic! At this time your incisions typically are closed and should be healing well. Up until this point, your incisions have been kept clean and dry. Now you will be able to shower and get them wet. However, it is not advisable to submerge your incisions under water such as in a bathtub, jacuzzi, or swimming pool until at least three weeks or until all incisions are healing well and closed.
The goal of wearing the steri-strips after your second dressing change is not to keep your incisions from opening back up. Typically by 10-14 days post-operatively, your incisions should be closed and healing well. Dr. Lowe makes your incisions carefully and makes them as minimal as possible. Special attention is also made when closing your incisions. After surgery care is critical in managing how they will heal and look.
New skin formed in the incisions after surgery is not as strong as normal skin. This strength is called tensile strength and the healing process is quite lengthy. However, the first 4 weeks immediately after surgery are very important in regards to the overall healing process to minimize scarring. The new skin in your incisions can be easily stretched due to low tensile strength. The goal is to reduce as much tension as possible on this new skin during the initial healing process. The concept is if you can reduce this tension, can reduce the potential of having such a large scar. As advised at your second post-operative office appointment, the use of steri-strips is recommended. Most patients, if cared for appropriately, can wear their steri-strips up to 4 weeks post-operatively to assist in incision healing during this initial healing phase.
SHOWERING & CHANGING YOUR STERI-STRIPS
After your second dressing change, you can return to showering as normal as possible, depending upon how your incisions are healing, of course. You will be advised at this appointment if the following guidelines need to be modified.
Remove your elastic bandage prior to showering. When you shower, your steri-strips will get wet. Wash with whatever bath products you normally use, just try not to use soap products directly over your steri-strips. Most bandaids or other adhesive dressings do not retain their adhesion on the skin if you wash with soap. General soap and water flowing over your steri-strips is normal.
Change your steri-strips approximately every 4 to 5 days, after your second office visit, usually until 4 weeks following surgery. On the day you want to change your steri-strips, remove them carefully prior to showering. Peel the both edges of the steri-strips towards the incision. Once you peel the sides up, begin at the top and remove them gently from the top to the bottom of the incision. Some dead skin may come off with the steri-strips. It is not recommended to remove steri-strips like you would a normal bandaid. Steri-strips are placed directly over the incision. Pulling them off like most people do with a bandaid can cause the new skin to get irritated or broken. Repeat this process for each set of steri-strips on each incision or portal. Also it must be noted that it is normal to have patches of clear brown to possibly green areas on the undersurface of your steri-strips. Oils in your skin are secreted in the incision and when these oils dry, it can change to a greenish color. This is quite normal.
Once the steri-strips are removed, shower as you normally do. Since the steri-strips are removed you can wash with whatever bath products you normally use over your incisions. After you have lathered and rinsed your body, wash the affected area again with antibacterial soap. Gently lather the antibacterial soap over your incisions and wash for about 30-40 seconds. Rinse and repeat for another 30-40 seconds.
Antibacterial soap and hydrogen peroxide both kill any potential germs on the surface of your skin. Cleansing with hydrogen peroxide can be tricky and quite messy. You are already going to get your incisions wet in the shower on the day you change your steri-strips, might as well wash with antibacterial soap. Antibacterial soap has two benefits over hydrogen peroxide. Since it is soap, it will remove any surface dirt and oils. Next, when you wash over your incision you are gently exfoliating dead skin cells off your skin. Removing excess oils and dead skin cells off the surface of your skin allows the new steri-strips to adhere better and stay in place for another 4 or 5 day period with normal showering.
After you shower, allow your incisions to dry for about ten minutes. Apply a new set of steri-strips. Begin by placing the steri-strip on one side of the incision or portal on the skin. Then gently pull towards the incision and seal down securely. Do not pull so much that you fold the skin. Folding the skin will allow more water to penetrate under the steri-strips and not allow the incision to stay dry between showering. Repeat applying the new steri-strips from the bottom of the incision to the top as it was demonstrated at your second office appointment.
For arthroscopic procedures, your initial dressings will be changed on your initial post-operative office appointment. At that time you will be advised that you can shower and change your steri-strips as described above. It is not advisable to submerge your portal incisions under water such as in a bathtub, jacuzzi, or swimming pool until at least three weeks or until all incisions are healing well and closed.
Steri-strips, or similar products, can be purchased at any local Walgreens, CVS Pharmacy, or Wal-Mart.