What guidelines should I follow when managing post-operative care for patients who have undergone plastic surgery?

When managing post-operative care for patients who have undergone plastic surgery, follow these key guidelines:

• Prevent surgical site infections (SSI): Avoid routine insulin administration in non-diabetic patients for glucose control postoperatively as it does not reduce SSI risk. Do not use wound irrigation or intracavity lavage to prevent SSI. Only apply antiseptics or antibiotics before wound closure within clinical trials. Consider antimicrobial triclosan-coated sutures to reduce SSI risk, especially in paediatric cases. Use sutures rather than staples for skin closure to reduce superficial wound dehiscence. Cover surgical incisions with appropriate interactive dressings at the end of surgery. Use aseptic non-touch technique when changing or removing dressings. Use sterile saline for wound cleansing up to 48 hours post-surgery, and advise patients they may shower safely after 48 hours. After 48 hours, tap water may be used for cleansing if the wound is open or draining pus. Do not use topical antimicrobial agents for wounds healing by primary intention. For wounds healing by secondary intention, use appropriate interactive dressings and seek tissue viability nurse advice as needed. If SSI is suspected, treat with antibiotics covering likely organisms, considering local resistance and microbiology results. Avoid certain debridement agents like Eusol and enzymatic treatments for SSI management. Employ a structured approach to wound care including preoperative assessment and education to improve outcomes ¹.
• Monitor and manage swelling, oedema, and scars: Educate patients about expected swelling and signs requiring medical advice. Consider alternative causes like deep vein thrombosis if swelling is unexpected. Initiate circulation exercises and limb elevation to reduce swelling. Compression bandaging may be used under specialist supervision. Support scar management by encouraging patients to desensitize the affected area through visualisation, gentle touch, and movement. Reassure patients that pain and itchiness are normal and may change during recovery ³.
• Specialist involvement: For complex wounds or injuries, involve tissue viability specialists and plastic surgery teams as needed. Orthoplastic centres provide combined orthopaedic and plastic surgery expertise for complex cases ².