If you think the wound is infected ( extremely rare) or if pain is progressively increasing then return for review immediately.

1. Office Hours Monday to Friday:    8:00AM - 4:00 PM

 Ring  Dr Myers Rooms   9650 4382

2. After Hours or Weekends:

Contact the hospital where the surgery has been performed.   

Hospital

Prince of Wales Private 

( P.O.W.P.)  9650 4000

Ask for Assistant Director of Nursing   ( A.D.O.N.) 

 Kareena Private Hospital 

 ( K.P.H. )     9717 0000   

Ask for Assistant Director of Nursing   ( A.D.O.N.) 

Sydney Surgical Centre 

 ( S.S.C. )  9399 8844

Ask for Nurse Manager 

Note S.S.C. not  open after hours or on weekends so contact P.O.W.P. 

Some swelling is inevitable after hand surgery or injury to the hand. Elevation of the hand is very important in the early days after surgery. During this time the hand should be kept at a level that is higher than your heart. This means when seated or lying that you rest your hand on a pillow. When walking around wear a sling. This allows fluid to drain from the hand. A swollen hand will be more painful, and a swollen hand will also predisposes to significant finger and wrist stiffness. Hence prevention of swelling is better than trying to treat swelling. It is important to make a full fist and fully straighten your fingers ten times an hour after any hand surgery or injury that does not involve a tendon repair or some fractures. This motion will pump the fluid out of the fingers and thereby prevent swelling. Apply ice directly over the hand bandage for 20 minutes every 2 hours while you are awake until your follow up appointment or as long as there is pain and swelling.

It is generally considered unsafe to drive with a splint in place. However there are several studies which note that many people still drive with casts and splints.

There is very limited or no advice available from the RTA website, insurance companies or the NRMA and limited research about this topic. It is unclear whether insurance companies will cover people wearing splints who are involved in accidents and it is also unclear whether patients could be potentially considered to be driving negligently if they are involved in an accident. While the general perception is that if a doctor says that a patient can drive they will be covered by an insurance company -This is unclear.

Your ability to drive safely will be determined by numerous factors relating to your car such as whether it is automatic or manual. Also many patients having surgery to the left hand have difficulty undoing a hand brake or changing gears.

A Colles cast on the right hand seems to have little impact on the ability to drive once it is painfree.(1)

Another study concluded that one can “advise our patients to drive once they feel safe, but they should be careful during the earlier stages of rehabilitation. If in any doubt, the driver should contact the RTA and take advice accordingly from their medical advisors”.(3)

My recommendations to patients are that:

“ You cannot drive after any hand injury or surgery until you can safely turn the wheel in an emergency to save yourself or someone else”.

Also “You cannot drive safely if you are still taking pain killers or have:

- An above elbow cast
- A scaphoid cast or Bennetts fracture cast
- An unstable fracture
- A cast on your left hand driving a manual car.
- A flexor tendon splint”

This list is by no means exhaustive and a decision to drive in a splint should be taken by the individual. It is usually clear for a given condition when you must not return to driving. On the other hand it is often not clear when you may return to driving after a given injury or operation because this varies greatly between individuals.

The operation report will give specific instructions on how to look after your wound. In general there are 2 types of sutures used to close your surgical wound.

1. Nylon sutures

- Small wounds eg trigger finger, Carpal tunnels should be kept dry for 2 days and then can be wet in the shower.

-  This is an interrupted suture that can be seen from the outside and crosses the wound edges from side to side.
It can produce a scar with a criss /cross appearance rather than just a straight line.

-  I use them particularly if early movement of the part is desirable. For example in the finger after a fracture.

- 50 Nylon is particularly used in fingers, on the palm and in Dupuytrens surgery.

The “50” refers to the gauge or size of the suture - Not fifty sutures!  

2. Monocryl sutures

- 50 Monocryl  subcuticular is a buried suture. It tends to leave a better scar which is a straight line scar.              .

- Must be kept dry and leave dressings and steristrips intact for 10 days.

-  Monocryl is a dissolving suture which can be left in-situ and will  dissolve spontaneously over weeks to months.

- It is often combined with small white tapes called  steristrips which are glued to the wound at the end of the operation with Op site spray. These must not be removed until at least the post operative visit.

- The ends of the Monocryl sutures are often tied over the steristrips to prevent the wound pulling apart.                      

- Even though Monocryl sutures can dissolve I often remove these sutures and leave the steristrips until they fall off.

- Removing the suture may improve the long-term appearance of the wound.

- The Monocryl suture can occasionally  cause an allergic skin reaction in some people.

- In longer wounds I just cut the ends of the Monocryl sutures flush with the skin after cleaning with alcohol swabs.    

- Monocryl is particularly used on the back of the hand and in the forearm.

- Must be kept dry and leave dressings and steristrips intact for 10 days.

Dressings and plasters

- Your hand will be dressed with a non stick dressing called Mepitel and then a pad of Velband then a crepe bandage following your surgery.

- This dressing should stay intact until your follow-up appointment unless indicated in the operation report.

- You will only need dressings for the first 10 days or so until primary healing has occurred.

- Depending on the type of surgery you may well have a plaster slab bandaged to the wrist or hand over the dressing.

- Often this is for comfort only and can be removed soon after the surgery to allow early movement.

- Just unwrap the outer bandage and the plaster slab will come off. Leave the inner dressing intact.

- Occasionally, there will be a small amount of blood in this dressing which is nothing to worry about, however if you see a lot of bleeding please contact the hospital or my rooms.

- Note for fractures and tendon or ligament repairs it is vital to keep the plaster slab on until instructed to remove it. Please follow carefully  the plaster  instructions in  the operation report.

- The plaster slab is not waterproof.

- After some operations the dressing will be changed after 24 hours.

- Your second dressing is usually much less bulky than the first and is often worn under a splint.

- Do not apply Detol, Betadine  or any other ointments over the incision!

Washing & Showering:

- It is very important to keep the wound dry. If you wish to take a  brief shower, tape a bag over your bandage and hold it well above your head to prevent water dripping inside your dressing.

- Do NOT take a bath, get into a pool or hot tub, or soak your hand for 2 weeks after surgery!

- The yellow discoloration you might  find around your surgery site is a long lasting surgical prep called Betadine.

- This is used because it will kill bacteria on your skin This yellow discoloration can be sponged off the day after surgery.

- More recently I have used Alcoholic Chlorhexidine to prepare the skin. It is placed in a bag and left on the skin for 10 - 15 mins before the operation. It is highly effective at cleaning the skin BUT it can dry out the skin and you are recommended to apply Sorbolene to the skin outside the dressings to moisturise the skin after the operation.

- If it is causing your arm to itch it can be removed sooner. Be careful not to wet the dressings at this time.

 
 Suture removal

- Stitches are usually removed  ~  8 - 10 days after hand surgery.

- A scar massage program is then begun, using Sorbolene or Olive oil firmly rubbed into and around the scar for five minutes, twice a day.  

- The oil may be purchased without a prescription.  

- Continue the massage program until the scar softens.

Early movement is crucial to an optimal recovery and I will specify to you if you are to limit this mobilisation in any way.
Eg some fractures, tendon or ligament repairs and skin grafts.

Early therapy following tenolysis (freeing of scar tissue around tendons) or arthrolysis
(release of scar tissue around joints) is critical to your outcome.
In these circumstances an appointment with a hand therapist should be made the day after surgery.  

Swelling and stiffness about the hand is expected for the first several weeks following your surgery.

Gentle range of motion exercises with your fingers will help to reduce swelling and stiffness.

Avoid lifting anything with your operative hand until your follow-up
appointment.

YES.

You must not drive home.

The only exception is if you have had a procedure under Local anaesthetic only.

Usually  7–10 days after surgery.

Some discomfort, swelling, and stiffness are normal. These will gradually improve.

Keep the hand well elevated.

Local anaesthetic is often used. The hand may be numb for 24 hours.

Please contact our rooms if you experience:

• Increasing pain uncontrolled by pain relief provided.

• Redness or discharge

• Fever

Unexpected swelling. If you feel the cast is too tight elevate the hand. If this continues the cast needs to be loosened.