Wound care and scarring
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Caring for your wounds after surgery
To achieve the best possible end result after surgery, it is important that sutures (stitches) and, later, scars are given proper care. If you wish to take pain-relieving medicine after leaving hospital, paracetamol is best. Aspirin, or aspirin-containing compound preparations, and medications containing non-steroidal anti-inflammatory ingredients (like Nurofen, Brufen, Ibuprofen, Ibuleve etc) can occasionally cause the wound to bleed. After any operation, it is beneficial to elevate the affected part. This reduces the swelling and discomfort which is normal after surgery and speeds healing. If you have had an operation on the face, sit up rather than lying flat, and sleep with an extra pillow for five days. Hands should be elevated on pillows at night and in a sling during the daytime. Similarly, a leg or foot should be rested on a high stool as much as possible.
Wounds may be sutured in a variety of ways. Non-dissolving stitches must be removed. The timing of suture removal is variable and depends mainly on the site of the wound. For the face it is between two and six days but elsewhere may be as long as two weeks. Dissolving stitches are often left beneath the skin to provide support; occasionally the body does not dissolve them and instead extrudes them, so that a strand begins to poke out through the skin months or even years after surgery. It is best to trim the protruding stitch flat to the skin with some boiled scissors, put a smear of antiseptic ointment on it once or twice a day until it has been completely discharged.
Please keep the wound dry until you have been seen for review and stitches removed. If a crust builds up around the stitches, it can be removed with a cotton bud dipped in warm water and, after washing, you should apply a fine smear of antiseptic ointment over the wound (usually Chloramphenicol “eye” ointment). When you are able to begin washing the area again, do so gently with soap and water and pat dry with a clean towel. Do not pull at the wound or soak it as this may cause it to stretch. If your wound should become very red, hot or tender, or if pus begins to leak from it or to build up beneath it, you should contact us immediately.
When the stitches are out and the wound soundly healed, the scar should be massaged with a little Nivea cream twice each day for three months. This will soften the scar and help it to fade more quickly. A special silicone preparation called Silgel or Dermatix can be even more effective, and can be applied a week after the sutures have been removed. Most scars take three months to reach full strength and for this period are active, red and a little raised and lumpy. After this they fade and flatten, this full maturation process usually takes at least nine months to one year but varies according to individual skin types and can be as long as eighteen months. If scars do not begin flatten after three months, it may be because they are becoming hypertrophic or keloid. Those with red hair and fair skin tend to develop scars which stay redder longer than those with a darker complexion. Those with afro-caribbean or asian heritage are sometimes more likely to develop keloid scarring. Do not scratch the scar as it may stretch. If itching is a problem, Eurax ointment may help.
The following articles give useful information about scars and keloids: https://www.bupa.co.uk/health-information/directory/s/surgical-wounds. If you are concerned that your scar is becoming hypertrophic or keloid, please book an appointment for consultation / review and possible steroid combination treatment.