You have had a procedure or operation under the care of the Fife Hand Service.
What happens next?
We are planning to put you in charge of any ongoing care you need, with support available if and when required. You can access us via the links on the Contact Us link. If things are going according to plan, the next contact we make with you will be at around 1 year for audit follow up, and we are always very grateful to you for taking the time to help us with our ongoing research and this helps us to continue to improve the service we offer.
If things are not going according to plan, or if you are worried about anything in particular, please contact us and we will arrange review or give advice if necessary. We have identified the most common issues and these are highlighted below.
Ongoing Wound Care
All wounds should be kept clean, dry and covered for 10 days after surgery. This allows normal wound healing to start and reduces the risk of infection.
Wounds with sutures: Once the stitches are removed, we recommend that the wound remains covered for a further 2 days before leaving the wound open to the air. This allows the stitch tracks to heal over. It is safe to get the wound wet in a shower 2 days after removal of sutures. The wound should not be soaked in a bath for around 2 weeks after removal of sutures, to allow more time for the wound to fully heal.
Wounds without sutures: The wound dressing can be removed at 10 days and the wound left open to the air. It is then safe to get the wound wet in the shower, but you should avoid soaking the wound in a bath for a further 2 weeks.
Open wounds: If you have a wound which has been left open to heal, you should keep the wound clean, dry and covered for around 4 weeks after the surgery. Dressings should be changed 2-3 times per week. You should avoid getting the wound wet during the first 4 weeks. It is usually safe to shower with the dressing on by week 3, and change the dressing immediately afterwards.
During the healing process the wound is tender and often itchy. This is normal. It takes around 6 -12 months to settle into a thin white non tender scar.
When you have an operation, nerves on the skin surface are always divided in the wound. This can make the skin surface feel numb around the wound which can be permanent. It is very unusual for this to give any major problems but you should be careful when handling hot or cold objects.
When to contact us regarding your wound:
1) If any of your stitches fail and the wound gaps – this is rarely a problem, but we want to know about it.
2) If you have any signifiant leaking from your wound, or if the wound is giving an unpleasant odour – you may have a superficial wound infection, and we want to know about this.
3) If you feel that your wound is not progressing, or that things are going backwards rather than forwards, let us know and we can advise.
This is normal following surgery. In most cases this will settle within 2-3 months of the operation. Wounds in the forearm generally settle more quickly than those in the hand. The wound after a carpal tunnel decompression is particularly tender in the first month or two after surgery. This part of the hand is usually the first part of the hand to make contact with things, and because it is generally a little swollen after surgery, the tenderness is more intrusive.
Tenderness in a wound after surgery should slowly improve over the weeks. Rarely, long term tenderness is an issue.
Hypertrophic Scar Formation
This is a condition in which the scar increases in width and feels lumpy. It can give rise to a cosmetic issue but is not serious.
You should mobilise your shoulder, elbow, wrist and hand immediately following surgery unless specifically instructed not to do so. Please refer to our mobilisation page here. If there are any major problems with the movement in your hand which we were not expecting, then we would like to hear from you.
When to contact us regarding mobilisation
1) If you feel that you are unable to move your hand because of pain or because of swelling, then we want to hear from you.
2) If you feel that your hand is getting stiffer rather than more mobile with time, then we want to hear from you.
Working after an Operation
Time off work may be required following surgery, depending on the surgery you have had and the type of job you have. There are no hard rules about this. Patients with heavy manual jobs may need 4-6 weeks off work, whereas patients with office-based jobs often return to work within a few days. The decision to start working again is one that we expect you to make, and unless there are risks involved we do not generally get involved with this, other than to support in any way we can. If you need a sick line, please let us know and this can be arranged.
Driving after an Operation
The D.V.L.A. states that you require permission from your doctor to drive while wearing a splint, but you are advised to inform your insurance company if you are driving whilst using a splint. You should not drive after hand surgery until you are fit to do so. It takes time to recover from the effects of the anaesthetic. Some of the painkilling medication you may be prescribed will affect your fitness to drive. If your hand or wrist are painful or stiff you may not be able to drive safely. It is your responsibility to ensure that you are fit to drive in terms of the DVLA guidance in respect of your hand surgery, and in respect of any other medical condition that you may suffer from. There is detailed information on the DVLA website about fitness to drive and you should refer to that before driving. If you are in any doubt, consult your surgeon or GP and also your insurance company. Different motor insurers have different policies about medical fitness to drive and you should check you are insured before driving.
If you have any further concerns, please get in touch and we can help advise.
© Fife Hand Service 2020