Dermatology day surgery at Brighton General

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General Advice

This information is for you if you have been given a day surgery appointment at Brighton General Hospital, Elm Grove, Brighton, BN2 3EW.

Please contact the Dermatology / Plastic Surgery department on 01273 665030 as soon as possible if you are unable to attend your appointment. The department will rebook your operation, and give your appointment to another patient.

If you are planning to go on holiday shortly after your operation, please check with the department, as you may need to have stitches removed or dressings changed within the following two weeks.

What is day surgery?

Day surgery allows you to have your operation and to go home on the same day. As the operation is carried out with local anaesthetic it makes it much more convenient for you.

What is a local anaesthetic?

Local anaesthetic is a series of small injections to the skin in order to make the area operated on numb, so it is pain free. The needle itself pricks and the injection itself can sometimes sting for a short while. You will remain awake during your operation.

What does the operation involve?

For most operations cutting the area out and stitching it up in a line may be the only treatment that is needed. However, sometimes, a larger area of skin needs to be removed and this could involve a flap or graft. Each operation is different, but your consultant will tell you what to expect.

What do I need to do before coming for the operation?

To avoid any unnecessary cancellations it is important to follow these instructions.

• Please bring in a list of all of your medications and allergies
• Please take your usual medication that is prescribed for you as normal
• Please arrange for a responsible adult to drive you home or you may take a taxi. It is recommended that you do not drive; use public transport or walk, because it is not safe if you feel unwell. If possible please arrange to have someone at home with you for the first day / night. If you have no one available then you will need to make sure you have all necessary meals arranged, as you will need to rest for at least the first 48 hours. Please have some Paracetamol or similar pain relief at home. Do not use Aspirin as this could increase the risk of bleeding. If you are responsible for caring for another person, please make alternative care arrangements for that person for the first 48 hours after surgery
• Please ensure that you eat and drink normally before coming in for your operation. If you are diabetic please have your normal medication / insulin with your normal meals
• Please do not drink any alcohol on the day of your operation and for 24 hours after your operation
• It is advisable that you do not smoke until you have had your stitches removed or had your dressing changed. This will help the healing process of your wound
• We do not have any facilities in the department to care for children
• Please wear your spectacles if your operation is on your face, as contact lenses can damage the eye if left in during the operation
• Please do not wear make up if your operation is on your face or neck. Remove nail varnish or jewellery that is close to the site of your operation. If you are unable to remove any jewellery we will cover it with tape
• Please have a shower or bath the morning of your operation, this will help reduce the risk of infection
• Please wear comfortable clothes that are loose and easy to put on and take off, so they will not cause any pressure on your wound

What if I am taking Warfarin?

If you are on Warfarin you will need to have your blood taken for an INR 7 to 10 days before your operation, and again ideally the day before your operation, or at least 2 to 3 days before, as your INR on the day of your surgery needs to be 2.5 or under. Please discuss this with the person responsible for supervising your Warfarin treatment of this, so they can advise you of any necessary adjustment to your Warfarin dose. Please bring the INR results with you when you attend for surgery. Please contact us on 01273 665030 to advise us if your INR result is above 2.5 two days prior to surgery, as we may need to delay your operation.

What if I am taking other blood thinning medicines?

If you are taking Rivaroxaban, Apixaban, Edoxaban or Dabigatran please stop 24 hours before your appointment time. For all other blood thinning medicines including Aspirin, do not stop unless directed to do so by your surgical team. Sometimes we may need you to stop these types of medicine before your surgery but this depends on why you are taking the medicine and the exact type of surgery you will undergo.

What happens when I arrive at the hospital?

You will need to give your name to the receptionist who will direct you to the waiting area. All patients are asked to come into the day surgery at the same time, as this enables patients all to be assessed by the nurses and consented by the surgeon prior to the start of any surgery. The surgeon will explain to you what will happen during your operation and you will have an opportunity to ask any questions. You will be asked to sign a consent form, this gives us your permission for the operation to go ahead.

Patients are then prioritised according the their type of surgery and any particular requirements. We apologise, as this will inevitably mean that you may wait up to three or four hours before having your surgery. The staff will give you an estimated wait time. If you feel the need to leave the department please let a nurse know and they can advise you of a time to return.

When we are ready a member of the nursing staff will take you to a side room. You will need to change into a hospital gown. All of your personal items will be taken into the operating theatre with you.

Who will be in the theatre?

Usually there are two nurses and the surgeon in theatre. We are a training hospital and on occasions we will have nursing students and trainee doctors observing in theatre. Please tell the nurse on your admission if you do not want to have nursing students or trainee doctors present in theatre.

What will happen after the operation?

Following your operation the nurse will talk to you about how to look after your wound. Please feel free to ask any questions. If necessary an outpatient appointment will be given to you by the receptionist or sent in the post. A copy of the letter will be sent to your GP so that they are aware of any follow up care that is needed.

When can I go home?

As you are having a local anaesthetic you will usually be discharged within half an hour of the operation. We do ask that you arrange for someone to drive you home or you may take a taxi.

Will I need to take extra care after my operation?

It is very important that you rest for at least 48 hours after your operation. If you are a single parent or live alone, please make sure you have meals prepared as this will enable you to rest as much as possible. You will need to avoid any activities like shopping, cycling, and dog walking or anything that will push up your blood pressure. If your operation is to your head or face, avoid bending down and try to sleep on two pillows for the first couple of nights to keep your head raised to help reduce any swelling or bleeding. If the operation is to your leg it is important that you rest your leg whenever possible by keeping your leg raised, until the wound has completely healed. You need to avoid swimming, sports / exercise, heavy lifting and heavy manual labour for a minimum of 2 weeks, or until the wound is fully healed.

What do I need to do with my dressings?

You will need to keep all of your dressings clean and dry and in place until your stitches or dressing needs to be removed. Some stitches need removing either by your GP practice or in the dressing clinic. Other stitches dissolve away on their own and don’t need removing. You will be told what sort of stitches you have after your operation and when and where they should be removed. If you are having a flap or graft you will be asked to return to our dressing clinic.

What should I do if the wound starts to bleed?

It is normal to expect some oozing of blood from the wound. If you notice any bleeding, apply constant pressure with a clean cloth for 15 to 20 minutes (keep the pressure on continually). It should eventually stop, but if for any reason you are unable to stop the bleeding, during normal working hours (9am to 5pm) you should contact the dermatology department for advice. Out of hours you will need to attend your nearest Accident and Emergency Department.

What should I take for pain?

We recommend regular Paracetamol for pain relief. Do not take aspirin as this can increase the risk of bleeding. If you are prescribed aspirin for another condition then please check with the consultant when you can start taking it again.

How will I know if my wound has become infected?

Infection can complicate any operation and usually appears two to seven days after the procedure. If you notice increasing pain, redness, swelling, or you feel generally unwell please see your GP as soon as possible, as you may need a prescription for antibiotics.

Immediate Appearance

All skin surgery produces a scar. The scar will initially be raised and red but this will improve as the healing process settles down. This should eventually result in a fine line but occasionally you may experience stitch marks, a depressed scar, a raised scar (keloid), changes of skin colour or a stretched scar. Prominent scars are most likely to develop on the upper back, chest and lower leg.

Late Appearance

The cosmetic appearance of the scar will continue to improve for up to 18 months. Massaging a moisturiser such as E45 or Vaseline into the area twice a day for two to three months may help soften the scar tissue and aid the healing process.

Wound strength takes four to six weeks to develop and up to 18 months to fully heal internally. It is important to avoid demanding exercise for six weeks after your operation to make sure that the wound does not break open or stretch. This is extremely important for wounds on the legs, arms and upper back and chest. You or your practice nurse may wish to apply steri strips or micropore tape for four weeks to support the wound.

It is important to keep your scar out of the sun please make sure that you apply a sunscreen with a factor of at least SPF 15 or above and 4 stars.

When will I have the results of the operation back?

We usually have the results back to the department up to 6 weeks after your operation. You may have a follow up appointment when we will tell you your results or we may write to you. If your operation was for skin cancer and the results show that all of the area was not completely removed, you may be asked to come back to the hospital for a further operation. This means taking away the remains of the skin cancer plus a small amount of healthy skin. If after six weeks you have not heard from the department please contact the secretaries on 01273 665019.

Contact us

If you have any questions please contact Dermatology Department at A Block, Brighton General Hospital on 01273 665015 or 01273 665030 and a nurse will call you back.

Support Groups and further information

• British Association of Dermatology
• Dermnet NZ

Complaints

If you wish to make a formal complaint about any aspect of your stay in the department, please contact to the Chief Executive at BSUH at the, Royal Sussex County Hospital, as soon as possible. The Patient Advisory Liaison Service is a friendly, informal and confidential service who may also be able to provide help and advice with any concerns that you may have.

Telephone: Royal Sussex County Hospital 01273 696955 extension 4029 or 4588 or Princess Royal Hospital 01444 441881 extension 5909.

Comments

We hope that you will be pleased with your treatment in the department.

If you have any comments or suggestions, please let us know. We will pass any helpful comments to relevant staff to consider your ideas for improving the service. If you are unhappy with any aspects of your care, please talk to the nurse in charge of the unit. They will normally be able to help reassure you about any aspects of your care of problems that arise.