Postoperative recovery and care

Postoperative recovery is same as that for any other skin surgery as far as wound healing by secondary intention is concerned. All postoperative wounds on the face generally take a maximum of 1 week to heal, whereas that on other areas take at least 3 or 4 days more. Wounds on the back and feet take the longest time (at least 2 weeks) to heal. Wounds on the scalp also heal within 1 week. Larger and deeper wounds take a longer time to heal.

All patients are very impatient. They expect to recover very fast. Many do not understand the importance of wound care and follow-up. Many patients think that once the surgical procedure is complete, everything is done and the rest of the things will follow automatically. Hence, I feel it is our responsibility to explain and emphasize upon their minds that surgery is only the first half of the process. If patients wish to recover fast and best, they should understand the importance of proper postoperative wound care. Simultaneously, when patients expect a good cosmetic result, it is equally important for them to understand that wound healing until new skin formation (reepithelialization) is just 1 to 2 weeks, whereas the new scar formation process (collagen remodeling stage) lasts for 45 to 60 days depending upon the area of the body. If postoperative advice is not properly followed, the possibility of ugly scarring increases. Hence, I always incorporate this information about postoperative care and follow-up in all my informed consent forms, which I always explain to my patients in detail beforehand. I have worried about my illiterate and poor patients not following instructions and thus getting into trouble, but this has happened very occasionally with them, because even if they are unable to read they listen to verbal advice very carefully and follow meticulously. In contrast, some of the well-off, aristocratic, well-read, well-informed patients do not follow postoperative advice and care properly, and may land into trouble with scarring.

General Postoperative Care (Excision Wounds)

Wound dressing is done immediately postoperatively.
Dressing should be done daily except for some conditions (e.g., ingrown toenail surgery).
Oral antibiotic (choice can vary), such as Cefixime, Cefpodoxime, Cefuroxime Axetil, Ofloxacin, Levofloxacin, Ciprofloxacin, Azithromycin, or Roxithromycin, is given for 5 to 10 days.
Pain-relieving medicines nonsteroidal anti-inflammatory drugs (NSAIDs) are usually not required much except for cases of corns, calluses, palmar or plantar warts, keloids, hypertrophic scars, basal cell carcinoma, bigger or multiple lesions, and mucosal lesions.
A head bath should be avoided for at least one week for all scalp lesions.
Wounds on the feet or soles require extra precautions from wetting and bathing as well as dust.
All facial wounds should be covered with the smallest of dressings, because the patient may be embarrassed by big dressing and can be left open once the wound dries.
Topical antibiotic of fusidic acid or mupirocin or nadifloxacin is advised for dressing.
Superficial abrasions following facial scar resurfacing need not be dressed. Application of one of the topical antibiotics listed above is enough.
Soap should be avoided until wound healing is complete. Nonsoapy washes, like a combination of cetyl and steryl alcohol, is preferred to prevent irritation.