Pre-operative Advice
The aims and expectations of surgery will have been discussed with patients at consultation. Smokers have an increased risk of wound healing problems, and therefore should refrain from smoking for 4 weeks before surgery and for two weeks afterwards. Aspirin and related anti-inflammatories (ibuprofen, naproxen, diclofenac) should be avoided for a similar period of time.
The contraceptive pill or HRT should be stopped for 4 weeks pre-operatively.
Before Surgery
Patients are admitted on the day of surgery for pre-op checks by the nursing staff and seen by the Anaesthetist to discuss the general anaesthetic. Mr Adams will take photographs, draw on the arms and take consent. Leg stockings will be provided to reduce the risk of venous thromboembolism. These are worn until patients leave hospital.
During Surgery
The surgery takes 2 hours and is under general anaesthetic. Patients usually stay for 1 night, although they may go home if they live locally.
After Surgery
Drainage tubes are not usually required. Stitches are self- dissolving. Micropore tape is applied over the scars, which can extend from the elbow into the armpit. Soft but bulky dressings are used firmly to wrap up each arm from mid-forearm to shoulder. This can limit movement and may make eating with utensils and toileting awkward. The degree of discomfort is variable but managed with regular analgesia. Expect some mild puffiness to the hands and wrists for the first few days given the firmness of the dressings. Patients should not drive for 1 week. Work should be avoided for 2-4 weeks. Sporting activities may need to be curtailed for 6-12 weeks. The dressings are removed at one week and tap applied by the cosmetic nurse. Showering can resume after one week.
Risks and Complications
As with all surgery, complications can occur. In the initial stages, the main risks are of delays in wound healing or infection. A long-term risk is a lumpy or stretched scar. The scars do take up to one year to fade in colour. Asymmetry of scars may be evident. Whilst numbness may be noted both around the scar and into the forearm, this resolves over a few weeks. Very rarely, there may be a degree of permanent numbness along the inner border of the forearm (lower arm). Another rare observation is that of a cord-like lumpiness along the inner upper arm below the scar. This can be an inflamed vein called phlebitis which resolves without treatment.
Follow-up
Patients are seen at one week for a wound check. An outpatient appointment is made to see Mr Adams at 6 weeks and 6 months.