Post-Operative Cleft-Lift Instructions
Activity: There are essentially no restrictions on basic daily activities after this pilonidal surgery other than to be careful not to accidentally pull out the drain or have any direct trauma or repetitive chafing to the incision. This means no contact sports, or any activity where you might fall, for six weeks after the operation. This includes football, basketball, wrestling, snowboarding, skiing, horseback riding, biking, etc. It is OK to sit normally; it is better to sit straight so that the buttocks are slightly spread apart, than to sit on one side, and have the buttocks pressed together. Sitting on one buttock can cause problems with healing. There are no lifting restrictions.
Wound care: You may remove the outer dressing and change it any time, and it is preferable that you change it daily. It is best to keep a piece of gauze over the incision and the place where the drain enters the skin; and also to keep a small, folded, piece of gauze tucked between the buttocks at the bottom of the incision. This piece of gauze keeps the two sides of the buttocks apart, which allows air to circulate, absorbs drainage, and prevents the incision from rubbing against the opposite buttock. Change all dressings at least once a day for the first four days. After day four, if there is no drainage from the incision, it is OK to leave the dressing off, but keep the gauze tucked in at the bottom until everything is completely healed and there is no more drainage, which may take six weeks. Leave the Steri Strips on for 7-10 days unless they become very soiled with stool; if that happens, please remove them. There are stitches under the skin, and the incision will not fall apart without them.
You will have a small drain in place which will most likely be removed at the first post-operative visit, (which will be between four and seven days after the surgery). I’d prefer that you use as little tape as possible, and try to hold the dressings in place with your underwear or the mesh shorts that are provided at the hospital. If excess tape adhesive accumulates on your skin, nail polish remover works well to remove it.
Do not soak the wound, apply any ointments, antiseptics, or special dressings without discussing it with me or my office staff first!
Showering: It is OK to get in a shower after twenty-four hours and get the incision and the drain wet, but do not soak in a tub or go swimming. It is imperative that the area be cleaned after bowel movements – and using wet-wipes to clean the area, or showering at that time will usually do a good job at keeping the area clean.
Diet: There are no restrictions on diet after the surgery, but there are some recommendations. Eat a diet high in protein (meat, fish, poultry, etc). There are some vitamins and amino acid supplements that I recommend to promote healing. You can find information about that if you follow this link.
Constipation: Sometimes the pain medication can cause constipation. It is OK to take a stool softener or milk of magnesia as needed.
Antibiotics: I will have prescribed one or two antibiotics for you to take for the week after the surgery. Please take them as directed.
Pain: I will have injected some long-acting local anesthetic during the surgery. There is a new medication called Exparel, which can last as long as 72 hours, and I use this when it is available. When it wears off there may be a bit more discomfort than there was earlier. If needed, take the pain medication I have prescribed. If this is too strong or doesn’t agree with you take acetaminophen (Tylenol) or ibuprofen (Motrin, Advil) if you are not allergic to these and they do not bother your stomach.
Nausea: If you have nausea that started right after the operation it is probably from the anesthetic and will resolve by itself. If you were not nauseated initially, but developed nausea later, it is probably from the pain medication. If this happens, stop taking the prescription pain medication and try acetaminophen (Tylenol). The antibiotics can also cause nausea – but this is less common then nausea caused by the pain medication.
Follow-up appointments: Usually, I will want to see you approximately one week after the surgery to remove the drain, and then about two weeks after that to see how the incision is healing. If it looks good at that point, there may not need to be any further appointments. If there is any question about proper healing, I will want to see you 3-4 weeks later.
If you are a patient traveling here from a great distance this can be handled differently. If you have a local surgeon or wound care professional who is comfortable with drain removal, it is perfectly fine to have them remove the drain at one week. Follow up after that can also be by your local physician – and if things are healing well – if you can just call or email and give us a report, preferably with photographs. However, if there are any healing problems it is very important that you let me know about them, and either come see me or email me a photo. Since most physicians are unfamiliar with the details of the cleft-lift procedure, please, do not have anyone else operate on this, or do not perform any wound care unless you have discussed it with me or my staff.
About the drain
The drain is a clear plastic tube with grooves along the sides to allow fluid to flow from the inside of the body to the collection reservoir. The plastic bulb provides suction when it is compressed and the plug is in place. The drain removes blood or fluid, and will pull tissues together with negative pressure to help the wound heal. There is not usually much fluid in the drain after this operation.
Emptying the drain: The drain should be emptied and the bulb re-primed several times per day. The bulb should be partially compressed at all times. If the bulb is full and round, then it is not applying suction, and should be re-primed. You will need to record the amount of fluid coming out of the drain, and keep a daily total. It doesn’t matter if you measure the output in cc’s, ml’s, ounces, teaspoons or tablespoons. Please use the table on the last page of the information sheet that we will give you to record the output. This information will be important when deciding when to remove the drain.
If the drain should become disconnected from the bulb, clean the ends with alcohol or peroxide, and re-attach the tubing to the bulb. The drain attaches to the connector with the serrated outer surface.
Problems you may encounter with the drain:
The most common problem with the drain is that it gets clogged with small bits of blood clot or protein-like material. When this happens the drain will stop draining and there may be drainage around the drain onto the dressing.
The way to prevent and solve this problem, is to “milk” the drain periodically. Follow these steps:
(1) Squeeze the drain closed with the fingers of your left hand as close to the stitch as possible,
(2) While holding on with your left hand, take the thumb and forefinger of your right hand, squeeze the drain as high as possible, and run your fingers down the drain toward the bulb, pushing any material into the bulb.
(3) Do this as many times as needed to clear out the drain. You may find that putting a little hand lotion or liquid soap between the fingers that are going to slide down the drain will make this easier.
THE DRAIN SLIPPING OUT:
These drains usually stay in place very well. There is a small black suture holding the drain in place. The drain itself has a small black dot which should be visible on the outside of the drain which is usually positioned right at the point where the drain exits the skin for reference. If the stitch should break, or come loose, nothing special need be done other than to make sure that the drain is securely taped to the skin.
If the drain should accidentally be pulled out a little, this is not a problem as long as the bulb stays compressed and can still apply suction. If the drain has been pulled out too far, the bulb will fill with air; there will be a whistling sound when the bulb is set; and it will rapidly re-inflate. You may see several small grooves on the surface of the drain at the point where it is slipping through the skin. If this happens, please call my office. The drain may need to be adjusted or removed. There is about four inches of drain under the skin.