A Handout to Optimize Post-Surgical Outcomes
Proper wound care helps avoid acute and long-term complications. Patient education and a comprehensive handout can help.
At Newport Skin Cancer Surgery (Newport Beach, CA) we focus exclusively on oncologic skin surgery (Mohs micrographic surgery, atypical nevi, and melanoma removal) for patients referred to us by local colleagues. As such, patient education on post-op care and wound management is an integral part of what we do. Proper wound care supports healing and optimal cosmesis, and it minimizes post-operative complications like infection. Patients who properly tend to wounds will be attentive to changes and can identify any minor problems before they become significant concerns.
One challenge is that Mohs patients receive post-operative instructions at a time of relative high stress. Despite our best efforts to ensure patient comfort and provide assurances, they may be anxious and tired after Mohs surgery and the subsequent reconstruction. Even with pre-procedure education and discussion through the process, patients may be distressed by the appearance of a post-surgical wound—especially if the site is on the face or other highly visible area.
Providing a comprehensive post-operative care handout is good practice. On the following page, I have provided a copy of my office handout. It may not be perfect, and it may not be ideal for every practice, but it has served my patients well and it may serve as a guide for those looking to update or create their own forms. In addition to a handout, we recommend patients watch our online wound care video, which was created specifically to reinforce what we teach them in the office.
The following tips expand on additional points and considerations for patient education and post-op wound management.
- Consider using unused absorbable dyed sutures for your top, percutaneous sutures and remove them as you would non-absorbable suture. The savings can be significant over time.
- For pain relief, two regular-strength Tylenol and two Advil taken together is essentially equivalent to one Vicodin.
- Consider omitting top sutures and placing deep sutures and steri-strips only for wound closures below the face. Tram/train-track scars are completely avoided. Appropriately strong, deep sutures and proper post-op activity counseling—not superficial sutures—prevent dehiscence.
- Though its long-term effect on wound healing has been debated, we find that hydrogen peroxide can be used for cleansing wounds for approximately one week with no harmful effects. The bubbling action gently debrides the wound of serum and blood.
Be Clear. Assess your forms for clear simple language, and a large, easy-to-read font. Keep in mind that some elderly patients may have trouble reading small fonts. Avoid photocopies of photocopies that may become hard to read.
Give Them a Post-Op Pack. Offer a post-operative care kit with Aquaphor or Vaseline/petroleum jelly, hydrogen peroxide (3%), gauze and/or Q-tips for cleaning, Band-aids for small wounds; sterile non-stick pads (such as Telfa), and paper tape and (generic or name brand) Hypafix. This way you know patients have the appropriate materials on hand and can undertake proper wound care immediately at home. It is easy for staff to make up these packs, the cost is negligible, and the good will afforded to the patient for this additional care goes a long way. Be sure to print your emergency contact information on or place it within the pack.
Make Medication Access Easy. Consider selling generic medications in your practice. Items such as topical and oral antibiotics can be dispensed by many practices. Check local laws to determine if/how you can do this in your state. Patients will be grateful for the convenience, especially after surgery, when waiting in line at a pharmacy (where they may be self-conscious with their pressure bandage), or making an additional trip when tired, may be less than ideal. By arming patients with medications before they leave the office, you increase the likelihood they will use them.
Make the Call. Personally call patients one to two days after surgery—not your nurse, office manager or rotating medical student, rather you personally make the call. This is probably, hands-down, the most efficient way to 1.) demonstrate compassion and concern, 2.) capture early any pending complications, 3.) address patient comfort and pain relief, 4.) save calls to the office about specific wound care matters, 5.) breed good that supersedes the best malpractice insurance, and 6.) demonstrate a level of service and care that patients state, “is unheard of these days.” I’ve personally found that patients may be a bit too distracted by post-op pain when calls are made the night of the procedure; good post-op instruction and discussion will address immediate pain concerns. We also prepare patients with a comprehensive “expectations” sheet where pain and other post-op symptoms are addressed.
Provide Contact. Consider adding your cell phone number on your practice business card. What would you feel like if your physician gave you his or her cell number (like a VIP, perhaps)? For those physicians wishing to find ways to exceed patient expectations, this is another way to do it. In my experience, patients rarely, if ever, call. However, the gained trust and reassurance, as well as your availability, will pay dividends.
Adam Rotunda, MD, FAAD, FACMS of Newport Skin Cancer (newportskincancer.com) is Assistant Clinical Professor of Dermatology, University of California, Irvine.