After Surgery

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1. Care For Your Dressing

   Please do not remove your dressing or change it. The dressing protects your hand until you return to the office, and removing this dressing could disrupt repaired structures, causing a poor result. Keep the dressing clean and dry. Keep the hand elevated, either on two pillows while lying down or in the sling provided. Commercially made waterproof covers are available in the office. Do not let your hand hang by your side as this will cause swelling and increase pain.

2. Pain & Pain Medication

   A long acting anesthetic is usually placed in the wound at the conclusion of the operation in order to decrease postoperative discomfort, causing some tingling and numbness until the anesthetic wears off in 24 to 48 hours. Do not be alarmed by this. An adjacent finger may be tingly as well. Fill your prescription and take as prescribed. It is not necessary to take the pain medication if you do not have pain. The medication should not be continued for any longer than is absolutely necessary. It is acceptable to stop the pain medication and take Tylenol or aspirin if this is sufficient. Rarely will pain medication need to be refilled. For refills, you must contact the office between the hours of 9:00 a.m. and 5:00 p.m. Monday through Friday and supply the name, location and phone number of your pharmacy. Pain medication will not be refilled after 5:00 p.m. Monday through Friday or on the weekends. We do not refill routine medication prescribed by other physicians. You must contact the prescribing physician for such refills.

3. Post Op Activity & Driving

   Please do not engage in any strenuous activity, such as yard work or jogging. In order to avoid injury to yourself or others, you are instructed not to drive an automobile or operate machinery until you are completely recovered from your operation.

4. Patient Home Therapy & Wound Care Instructions

   Follow these instructions only when the surgeon tells you it is O.K. to do so. You can maximize your hand’s motion and minimize the scar by following these instructions in addition to any instructions the hand therapist may give you. Fill the sink with warm water three times daily. You need not add anything to the water. Soak the hand for 15 minutes and squeeze a dish sponge in the water. Afterwards, massage all the wounds very firmly with hand lotion. The type of hand lotion is not important rather, the pressure from the massage remodels scar tissue. This intermittently applied pressure can actually flatten out scar tissue for several months after surgery, similar to the way compression garments minimize burn scars. Scar tissue reaches its peak between the fourth and sixth post-operative weeks and, typically, this is the time period in which the wound looks it worst. During this time, it is most red, firm and tender. This is the natural healing process, and attention to the massage three times daily for at least two months will desensitize the wound and minimize the scar. Any injury to the hand, whether it be traumatic injury or surgical trauma, causes the hand to swell.

5. After surgery, when can I resume my medications?

   After surgery we will tell you when to resume your home medications. Typically, we will allow you to return to them almost immediately. Especially if they are for treatment of heart, lung, or kidney problems.

6. Do I have an infection?

   A wound infection or an infection at the site of surgery. Increased pain may be the first symptom you feel. The amount of pain is usually a significant increase and not the typical post op pain. You can also look for foul smelling drainage, increased swelling, or redness.   A mild elevation in temperature does not mean that you have an infection. However we ask that you look at the wound if you’re concerned about an infection, please don’t hesitate to contact us immediately for appropriate treatment.

7. How long after surgery will I be able to drive?

   One of the most common questions after surgery is regarding driving. You can drive when you are safe and when it is safe for other drivers on the road. This may be as early as two days or as late as six to eight weeks depending on the surgery you have had. The important thing is to practice before getting out on the open road and be sure that you are safe getting from the break to the gas and vice versa. Also keep in mind that you cannot drive under the influence of pain medication. So it is important that you do not take your pain medication when driving.

8. What do I do if my dressing is too tight?

   If your dressings are too tight, it is often because there has been additional swelling since surgery. The first thing to do is to elevate your arm. Usually with elevation and additional icing of your arm/hand the swelling will go down and the dressing will not appear as tight. However if it continues to feel too tight, it is okay to unwrap the dressing. But do not remove it, as it is helping us control the bleeding. Any questions, or numbness or blueness of your fingers, please don’t hesitate to call us.

9. What do I do if there is bleeding through my dressing?

   Following surgery, you may have bleeding through the dressing that I put on at the time of surgery. Often this is about the size of a quarter or maybe even just slightly larger. Please don’t remove the dressing, but reinforce it. This would involve putting another dressing on top of the current dressing. However, if it continues to bleed and you’re concerned about the amount of bleeding, please don’t hesitate to contact us.

10. What is Home Healthcare?

    Home Healthcare will involve a registered nurse coming out to your home the following day after you are discharged from the hospital. The registered nurse will work to evaluate your wound, asses your vitals, teach your medication, and remove the staples when needed. You will see the nurse for approximately three to four visits before being discharged. The home health physical therapy will start the following day you are discharged from the hospital. A physical therapist will work to instruct proper technique, reducing swelling, regaining your range of motion, and restoring your normal gate by use of assistive equipment, like the front wheeled walker, or cane. They will also answer any and all questions with regards to home physical therapy.

11. What will be my restrictions after surgery?

    In most surgeries of the hand/arm, restrictions will be based on how much pain and discomfort you may have, as well as what has been repaired or reconstructed.

12. When can I shower?

    Following surgery, you may shower following your first dressing change. This typically occurs at two days after surgery, but please keep in mind that it is important to cover the incision or incisions if there is any drainage. Remember what can come out, can go in. When you decide to shower, it is important that you pat down afterwards and keep the areas dry as possible.

13. When can I swim?

    Following hip, knee, or shoulder surgery, you may swim when the incisions are closed and healed. Typically this occurs anywhere from eight to ten days after surgery. Please be sure that your sutures or staples have been removed. If there is any drainage from the wound, please do not submerge the limb, no baths, no pools, and please be careful in a shower.

14. When do I schedule my follow up appointment?

    It is important to schedule your follow up appointment before surgery. This way you will know when you are coming back to the office to see us. This can be as early as two days, ten days, or even three weeks after surgery.

15. When do I start taking pain medication?

    After surgery, it is important to take your pain medication as soon as you start to feel pain. Following the surgery, you should try to eat something or get something in your stomach to prevent the side effects of the medication.

16. When do I stop taking my asprin pre-operatively?

    After hand surgery, you may have been asked to take aspirin twice a day. The risk of blood clots drops significantly three weeks after surgery. Therefore, you may continue taking the aspirin, coumadin, or plavix up until the day before surgery.

17. When should I go to the Emergency Room?

    Following surgery, there may be circumstances that require you to go to the emergency room. Certainly any chest pain, shortness of breath, or difficulty at home, please don’t hesitate to contact an ambulance and go to the emergency room. However, if you have a question about drainage from your wound or possible infection, please refer to this website or even contact our office to answer those questions. As you would imagine, the emergency room often has a long wait, and often we can take away the need for you to go to the emergency room by answering these questions for you.

18. When will I be able to get back to physical activities?

    Everybody’s concern after surgery is getting back to the activities they enjoy. Following therapy, your physical therapists and myself will recommend when it is safe for you to return to activities such as tennis, bowling, golf, or even ultimate fighting. Please refer to the specific procedure on our website to get an idea of when it is safe to return to those activities. Keep in mind that our goal is to get you back in your game.

19. Why am I stiff at night?

    After hand surgery, many patients ask my why my hand is so stiff at night. The reason is simple. At night you’re not typically moving the hand. You may notice even after sitting for long periods of time or being stationary, that same stiff feeling will occur. If you are awoken by a stiff joint, obviously the answer is to get up and move it. Whether this be making a fist or just simply moving it. This will make you feel better. Don’t be surprised if this could last up to two to three months after surgery.

20. Why do I not have sutures?

    After surgery, when you change your dressing, you may notice that you don’t have sutures in your wounds. I prefer this. However, if there is bleeding from the wound during surgery, I may place a suture in the wound. Do not be alarmed if there are no sutures there.