Welcome to “Bizarro World”
Getting the right advice at the right time
Those of you old enough to have read Superman Comics may remember the Bizarro World where everything was the opposite of the real world. Sometimes our patients feel like they have entered Bizarro World when they come to our clinic because of the vast difference between the instructions and information I give my patients, as opposed to what they have been told in the past. The instructions I give are what I have found works for my patients with the operation I perform. So, I can’t say that the advice patients have received elsewhere by other surgeons is wrong, but I can say that they don’t apply to my cleft-lift patients.
Here are some examples:
- We encourage sitting immediately after surgery! I believe that this is actually beneficial for the incision, since it opens up the bottom of the cleft and allows air circulation. I have never seen a situation in one of my post op patients where sitting has caused a problem.
- We do not recommend any type of hair removal. Once the cleft is flattened, hairs should not be an issue anymore.
- We close the wound. No open wounds, no packing, no complicated dressing changes.
- We do not recommend “packing” wounds, even when there are open pilonidal wounds. Loosely placing absorbent gauze in a wound is helpful, but packing is counter-productive.
- We use dissolving sutures. The large, external, sutures that many surgeons use do not guarantee that the wound will stay together; they leave permanent, unsightly stitch marks; and can be very uncomfortable.
- We allow showering the day after surgery. I would rather have the area around the incision clean. Letting the shower run on the incision and drain has not caused any problems in my patients.
- We recommend patients go back to fairly normal activity, as long as it is gentle on the incision. We do not recommend any period of immobility.
- We do not restrict lifting. Lifting when standing does not put any stress on the incision.
- We allow lying directly on the incision when sleeping. It is OK to sleep in any position that is comfortable.
- We never use silver nitrate on wounds. It is a caustic chemical that does more damage than good.
These instructions are often met with incredulous expressions, since they contradict all previous instructions – but this protocol works very well. I am trying to make recovery from the cleft-lift as simple as possible, and get my patients back to normal activity as soon as possible. There are certain instructions I give that are very important to follow, and this is all complicated enough without adding restrictions that aren’t necessary.
The success rate in our clinic of ~98% primary healing speaks for itself as far as the wisdom of this protocol, and our patient’s responses to our post op instructions have been positive, as you can see from the answers to our survey below.
