Standard excision
STANDARD EXCISION ie not skin grafts, flaps or purse string closures
LEAVE DRESSING ON UNTIL REVIEW WITH OUR NURSE, there is no need to apply an island dressing (fabric or water resistant) under any circumstances – this ‘tape’ like dressing is sufficient and reduces the chance of infection.
You can shower 24hrs after the excision has taken place and the dressing does NOT need to be change.
Exercise:
This depends on the location of the excision but typically (you will advised by your doctor) you should avoid heavy workouts/walking and sports for the first week and then you can resume gentle exercise on week two.
Review and Suture removal:
Your will be advise when to make an appointment with our nurse for wound check or suture removal at the time of the procedure
However do not wait for the wound to become grossly infected e.g. red and swollen with purulent discharge – if you have any concerns please our nurse for a review straight away, if out of hours attend your local GP
Pain:
It is normal to have a small amount of pain for up to 24 hrs after the operation.
Paracetamol should be able to be control this normal/expected pain.
If the wound becomes increasingly painful, especially at rest or from the 3rd day after the operation, please contact us immediately as this is often the first sign of infection.
Bleeding:
There may be a small amount of bleeding confined to the dressing this is NORMAL. Please do not disturb the dressing.
If the bleeding is excessive (completely soils or leaks from the dressing) or is persistent, apply pressure and seek medical input from our nurse or another medical professional if our of hours.
Scar care:
After suture removal another tape dressing will have been applied (where necessary), remove this at 7 days (don’t worry if it falls off prior) and then you can start to use a scar management gel – such as TRPRO+ gel (purchased from our clinic) or Strataderm gel (from any chemist).
Skin Flaps
LEAVE DRESSING ON UNTIL REVIEW WITH OUR NURSE, there is no need to apply an island dressing (fabric or water resistant) under any circumstances – this ‘tape’ like dressing is sufficient and reduces the chance of infection.
You can shower 72hrs after the excision has taken place and the dressing does NOT need to be change.
IF a pressure dressing has been applied you will be advise to remove this top layer dressing ONLY.
Exercise:
You should avoid heavy workouts/walking and sports/carrying heavy items like shopping bags for the first two weeks and then you can resume gentle exercise on week three.
Review and Suture removal:
You will be advise when to make an appointment with our nurse for wound check or suture removal at the time of the procedure.
However do not wait for the wound to become grossly infected e.g. red and swollen with purulent discharge – if you have any concerns please our nurse for a review straight away, if out of hours attend your local GP.
Pain:
It is normal to have a small amount of pain for up to 24 hrs after the operation. Paracetamol should be able to be control this normal/expected pain.
If the wound becomes increasingly painful, especially at rest or from the 3rd day after the operation, please contact us immediately as this is often the first sign of infection.
A hard black graft (not a dark purple graft) will be slower to heal and will need to slough off and then heal by secondary intention (will heal as a scar).
A graft may have a combination of the above colours.
A pink/purple graft with a raised black area around the edge of the graft should still heal well as will a small black area within the body of the graft.
Once you have been advised that you can get the area wet again you need to be extremely careful with the graft, you will need to change the dressing yourself (this will be a fabric island dressing) immediately after if gets wet and blot the graft with paper towel.
Apply Chlorsig eye ointment (we use this for surgical wounds not just eyes) twice daily to the graft very gently for 7 days and then switch to Vaseline for 4 weeks.
Suture removal
The sutures are usually removed at 2 weeks by our nurse.
Pain
It is normal to have a small amount of pain for up to 24 hrs after the operation. Paracetamol should be able to be control this normal/expected pain.
If the wound becomes increasingly painful, especially at rest or from the 3rd day after the operation, please contact us immediately as this is often the first sign of infection.
Bleeding There may be a small amount of bleeding confined to the dressing this is NORMAL. Please do not disturb the dressing.
If the bleeding is excessive (completely soils or leaks from the dressing) or is persistent, seek medical input from our nurse or another medical professional if our of hours.
Skin Graft
Full thickness skin graft
Start the provided antibiotics immediately
LEAVE DRESSING ON UNTIL REVIEW WITH OUR NURSE
Keep the skin graft dressing 100% DRY until advised otherwise – no plastic film dressings to be used.
If a dressing becomes damp from water, sweat or wound ooze contact our clinic immediately for a review with our nurse.
Minimize movement of the skin graft, even after the sutures are removed. This will give it the best chance of establishing a new blood supply and surviving, exercise such a the gym, long walks, excessive stair usage should not be undertaken until advised that it’s safe to do so, this is especially the case for the first week.
Do not wait for the wound to become grossly infected e.g. red and swollen with purulent discharge – if you have any concerns please our nurse for a review straight away, if out of hours attend your local GP.
The graft site
The Graft dressing is usually removed at 5 -7 day post procedure by our nurse.
The graft at this stage can often look quite unsightly:
A pink or dusky pink graft is quite healthy and will heal the quickest.
A purple graft has still taken but may take longer to heal and you may get the very top layer of skin sloughing off. This means the graft will take a bit longer to heal but will still heal well.
A hard black graft (not a dark purple graft) will be slower to heal and will need to slough off and then heal by secondary intention (will heal as a scar).
A graft may have a combination of the above colours.
A pink/purple graft with a raised black area around the edge of the graft should still heal well as will a small black area within the body of the graft.
Once you have been advised that you can get the area wet again you need to be extremely careful with the graft, you will need to change the dressing yourself (this will be a fabric island dressing) immediately after if gets wet and blot the graft with paper towel.
Apply Chlorsig eye ointment (we use this for surgical wounds not just eyes) twice daily to the graft very gently for 7 days and then switch to Vaseline for 4 weeks.
Suture removal
The sutures are usually removed at 2 weeks by our nurse. Pain It is normal to have a small amount of pain for up to 24 hrs after the operation. Paracetamol should be able to be control this normal/expected pain.
If the wound becomes increasingly painful, especially at rest or from the 3rd day after the operation, please contact us immediately as this is often the first sign of infection.
Bleeding
There may be a small amount of bleeding confined to the dressing this is NORMAL. Please do not disturb the dressing.
If the bleeding is excessive (completely soils or leaks from the dressing) or is persistent, seek medical input from our nurse or another medical professional if our of hours.
Purse String Closure
LEAVE DRESSING ON UNTIL REVIEW WITH OUR NURSE AT DAY 5 (approximately), there is no need to apply an island dressing (fabric or water resistant) under any circumstances – this ‘tape’ like dressing is sufficient and reduces the chance of infection.
You must not get the dressing wet at all until advised it’s safe to do so.
Exercise:
You should avoid heavy workouts/walking and sports/carrying heavy items like shopping bags for the first two weeks and then you can resume gentle exercise on week three.
Review and Suture removal:
You will be advised when to make an appointment with our nurse for wound check or suture removal at the time of the procedure – a review is typical around day 5 and suture removal is typically 3 weeks post excision.
From your review with our nurse you will be advised to apply twice daily Chlorsig eye ointment (we use this on surgical wounds as well) and typically at this point you only need to dress the wound if you wish to.
However do not wait for the wound to become grossly infected e.g. red and swollen with purulent discharge – if you have any concerns please our nurse for a review straight away, if out of hours attend your local GP.
Pain:
It is normal to have a small amount of pain for up to 24 hrs after the operation. Paracetamol should be able to be control this normal/expected pain.
If the wound becomes increasingly painful, especially at rest or from the 3rd day after the operation, please contact us immediately as this is often the first sign of infection.
Bleeding:
There may be a small amount of bleeding confined to the dressing this is NORMAL. Please do not disturb the dressing.
If the bleeding is excessive (completely soils or leaks from the dressing) or is persistent, apply pressure and seek medical input from our nurse or another medical professional if our of hours.
Scar care:
Once advised you can start to use a scar management gel – such as TRPRO+ gel (purchased from our clinic) or Strataderm gel (from any chemist).
Photodynamic Therapy (PDT)
Information on PDT using natural daylight (ND- PDT with ALA 20%)
– Typically we choose natural daylight activated – this means you will need to have 2 hours of daylight on the skin after the ALA gel has been applied by our nurse – We choose ND
– PDT as this is typically not painful (compared to red light) and produces the best outcomes
– PDT is a photosensitizing process that use ALA chemical which causes an oxygen free radical process to remove sun damage (actinic or solar keratosis)/early superficial BCC skin cancers.
– If is safe and typically has very few contraindications or interactions with medications – making it suitable for the majority of patients, your doctor will have reviewed your case to be sure it is suitable for you.
– If you develop a cold sore prior to the treatment please advise the clinic as we may not be able to proceed.
On the day of the procedure:
– Apply an untinted SPF 50 to a clean, un-moisturized, no makeup skin 30 – 60 mins prior to attending the clinic.
– If you have long hair or a fringe, please bring a headband or clips to keep hair off your face.
– Once the nurse has applied the treatment you will need to spend 2 hours in daylight – it is essentially this is a continuous period and not broken up, but the 2 hours can start once you drive home (driving time doesn’t count).
– After the 2 hours wash the treatment off with a bland face wash and then apply a bland moisturizer.
Aftercare:
– Your skin may be quite red like you have been sunburned after the first 12hrs, this is normal.
– Your skin will be extremely sensitive to light for up to 48 hours after treatment, SPF 50 and general sun smart care if strongly advice but you do not need to remain indoors.
– Your skin will begin to peel within 2-4 days. Do not pick, peel or exfoliate the flaking skin – showering/washing the face is totally acceptable but please use a simple face wash.
– Expect redness, peeling and occasionally crusting. Bleeding and pus are reasons to contact the practice.
– Bland, soap-free cleansers and moisturizes such as Cetaphil cleanser and moisturiser are ideal for the first 2 weeks.
– Pain and swelling can be treated with standard pain relief.
– Avoid applying ice or cool packs but a damp cloth may be applied if there is a little swelling.
– Your skin will begin to heal naturally within 7-14 days.
– Please contact the practice if you have any concerns.
– Please book a follow up appointment 8 weeks after the PDT.
Laser
Use TRPRO+ gel (purchased from our clinic) to obtain the best post laser appearance
Post laser appearance and sensation:
– The are may be pink and mildly swollen for up to 48hrs
– There may be tenderness and a slightly tinging/hot sensation for up to 12 hours – this is normal (seek advice if longer than this)
– Certain laser procedures may make the lesions treated appear darker and crusty – this is normal if you have had a lesion removed or had pigmentation treated
– After FRAX laser the skin might feel rough to the touch – this is normal and will settle within a few days.
You can shower the day of the laser but should avoid the applying the following type products:
– Anti ageing face creams, serums and toners, retinols or similar
– Exfoliants/scrubs
Use a bland moisturiser only for 7 days post laser
Sun exposure:
Sun exposure to the area should be kept to a minimum for the first 48hrs and SPF 50 applied.
Pain:
It is normal to have a small amount of pain for up to 24 hrs after the operation. Paracetamol should be able to be control this normal/expected pain.
If the wound becomes increasingly painful, please contact us immediately as this is often the first sign of infection.
Efudix
Information on these topical treatments
– Self-application of treatment at home
– Typically, we choose these treatments as a ‘risk reduction’ approach if you have solar/actinic keratosis
– Treatment can be use on most parts of the body either as a block or spot treatment, your doctor will advise on this
– Generally very safe and more cost effective than Photodynamic therapy (PDT) – the alternative to these treatments
Frequency, duration & what to expect of treatment:
– Frequency and duration treatment will be advised by your doctor, typically ranges from 2 – 6 weeks, once or twice daily applications
– Day 1-3 mild redness, Day 4-7 beginnings of mild scabs forming, Day 8 – 14 development of more noticeable scabs, flaking, redness and some discomfort (the healing process occurs over similar period)
– Majority of people return to mostly normal skin appearance with 4 weeks of stopping but occasionally pink uneven skin tone can last longer and very occasionally permanently.
Aftercare:
– You can shower as normal after the cream has been on the skin for at least 12 hours (ideally leave it on between showers)
– Your skin will be extremely sensitive to light during & after treatment, SPF 50 and general sun smart care if strongly advice but you do not need to remain indoors fully.
– Expect redness, peeling and crusting. Bleeding and pus are reasons to contact the practice.
– Bland, soap-free cleansers and moisturisers are recommended from start to finish of treatment
– Pain and swelling can be treated with standard pain relief
– Avoid applying ice or cool packs but a damp cloth may be applied if there is a little swelling.
– Please contact the practice if you have any concerns
– Please book a follow up appointment 8 weeks after treatment
