Pre-Op and Wound Care

Important Surgical Reminders

PLEASE DO THE FOLLOWING:

1. Prior to surgery, let us know if you have an artificial heart valve, prolapsed heart valve, history of rheumatic fever, joint replacement, or another prosthetic surgery. You may need to take antibiotics before surgery.
2. If you take antibiotics before dental procedures, please take them before your surgery.
3. Plan on being in the office for a full day. Please bring a book, computer, or something to occupy your time in between the different stages of surgery. It can take anywhere from 30 minutes to two hours in between stages.
4. Contact us as soon as possible if you must reschedule or cancel your appointment. If you are ill or have a fever on the day prior to surgery, please call us immediately.
5. Take a shower and wash your hair the morning of surgery. The surgery site must be kept dry for at least 48 hours after surgery.
6. Eat a good breakfast before your surgery and help yourself to the refreshments our office provides. You will need to remain in the office should your surgery go through the lunch. You may want to bring a sack lunch.
7. Take your usual medications unless instructed otherwise, including any blood thinner prescribed by your physician. Bring an updated list of your medications.
8. Dress warmly and consider bringing a light jacket, sweater, or a small blanket if you are particularly sensitive to the cold. The procedure rooms are kept at 68 degrees.
9. Have Tylenol (acetaminophen) on hand at home to take after your local anesthesia wears off.
10. Consider bringing someone with you if you have a skin cancer near your eye. A bandage may obscure your vision on the ride home.
11. If the surgical site is around your eyes or mouth, please bring a container for your contact lens or dentures (if you wear them).
12. Remove any makeup. If the area is in hair-bearing skin, please make sure the hair around the area is shaved.

DO NOT:

1. Take Aspirin/Ibuprofen/Advil/Aleve/Naproxen/Celebrex for 14 days prior to surgery unless prescribed by your doctor. If you have a history of cardiac disease, stroke, or blood clots, continue to take all your blood thinners
2. Take multivitamins, vitamin E, fish oil, and all homeopathic medications (i.e. gingko biloba) 7 days before surgery
3. Smoke tobacco for 2 weeks prior to surgery as this may disrupt normal wound healing
4. Consume alcohol for 48 hours before and 48 hours after your surgery.
5. Bring more than one family member (unless necessary) as our waiting area has limited seating. Avoid bringing children.
6. Use your cell phone in the lobby as a courtesy to other patients.
7. Exercise or participate in sports for two weeks following the surgery. During this time, you will be asked to limit all activities that increase your heart rate and not to lift objects heavier than a gallon of milk.

Activity Restrictions

The first 48 hours are the most critical time after your surgery.

PLEASE DO THE FOLLOWING:

1. Go home and sit in a recliner with your head elevated if possible and your feet propped up.
2. Sleep with an extra pillow to elevate your head.
3. Avoid bending over to decrease possible complications of bleeding, swelling, and pain.
4. Avoid any blood thinners including Aspirin (unless prescribed by your primary care doctor), Ibuprofen, Advil, Aleve, Motrin, and alcoholic beverages.
5. Only take Tylenol or pain medication prescribed by our office to control pain.

For two weeks following Mohs surgery:

• Do not participate in sports or exercise
• Do not engage in any activity that increases your heart rate
• Do no lift anything heavier than a gallon of milk.
• Do not shave over the sutures
• Avoid smoking
• Do not drive or drink alcohol when taking any prescribed pain medication

If Mohs surgery is performed near your eye (above or below), you may experience a black eye, severe swelling, or what appears to be a blister above or below your eye. These are not abnormal or unexpected and should resolve in a week or two.

If bleeding occurs, leave the bandage in place and apply direct, firm pressure to the area for 15 minutes without peeking. If you are still bleeding, repeat this and apply pressure for another 15 minutes without peeking. If bleeding persists, please contact us.

If you have any concerns please give us a call at (904)544-5800. After clinic hours, our line will have an option for urgent concerns, which will route directly to Dr. Al-Dabagh’s cell phone.

We will return your calls as soon as possible. If you are experiencing a life-threatening event, please call 911 or seek help at the nearest emergency department.

Wound Care - Bandaging

1. CLEAN THE WOUND

Use clean cotton balls soaked in hydrogen peroxide. Your wound can also be cleaned in the shower with a mild soap and water at this point.

2. VASELINE

Apply a thin layer of Vaseline (unless directed otherwise) over sutures. Fill open wounds entirely with Vaseline.

3A. FOR SMALLER WOUNDS

Regular band-aids will work for smaller wounds. Just be sure that only the nonstick (white) pad is touching the wound.

Fabric band-aids are recommended due to their flexibility.

3B. FOR LARGER OR IRREGULARLY SHAPED WOUNDS

For larger wounds, non-stick pads can be found at any pharmacy. DO NOT use gauze. Trim the pad to the size of the wound.

​Adhere to the skin using paper tape or skin tape. We recommend paper tape for patients with thin or sensitive skin.

WOUND CARE TIPS

When changing your bandage, notify the office if your wound has:

• Abnormal drainage
• A bad odor
• Redness and warmth around the wound
• Increasing pain
• Swelling
• Or you develop a fever.

Managing pain is essential for quality of care:

• You should not experience significant pain after surgery
• If wound is painful, take regular or Extra strength Tylenol (as this is not a blood thinner)
• In addition, a cold compress (i.e. cool wet towel) can be used over the area.

If these steps do not provide relief, please contact us so we can help!

ACTIVITY RESTRICTIONS

• No heavy lifting (over 5 lbs)
• Avoid strenuous activity
• Avoid bending over
• If your wound is open, restrictions may last 2 weeks or more.
• If you have stitches, restrictions last until stitches are removed.

Biopsy Care

PLEASE DO THE FOLLOWING:

1. After 24 hours, please remove the bandage.
2. Wash the area with hydrogen peroxide.
3. Apply a pea sized amount of Vaseline and a small band-aid to the site.
4. Repeat for the following week.
5. If there is any bleeding hold firm pressure for 20 minutes.
6. If bleeding does not stop call the office at (704) 230-1302 or seek medical attention.

Cryotherapy Care

PLEASE DO THE FOLLOWING:

1. Wash the area with mild soap and warm water daily. Do NOT scrub.
2. If a blister or scab form, please do not remove them as they are protective for the new skin.
3. If the skin breaks, apply a small amount of Vaseline and a band-aid.
4. Keep the area protected from the sun, this will aid in healing.
5. If you have any concerns, please call (704) 230-1302 or seek medical help.

Dissolvable Suture Care

Please wash your hands thoroughly before caring for the wound.

PLEASE DO THE FOLLOWING:

1. Leave the bulky, white pressure-dressing in place for 48 hours. After 48 hours, remove the dressing slowly and carefully to avoid pulling apart the underlying sutures. Do not remove the brown, skin-colored tape.
2. DO NOT GET YOUR WOUND WET FOR 7 DAYS! It is crucial that you keep the area absolutely dry for a week. Absorbable sutures may dissolve too quickly if they get wet, and your wound may open up.
3. The brown, skin-colored tape directly over the sutures should be removed 7 days after surgery. Some sutures may be dissolved or removed when the tape is taken off. Do not worry if not all the sutures are gone, as they will dissolve on their own with time.
4. After removing the tape, wash the wound once a day with mild soap and warm water. Gently pat dry. Do not scrub. Apply vaseline with a clean Q-tip and then cover with a Band-Aid or other form of non-adherent dressing.
5. Repeat this routine daily until the sutures dissolve and the wound completely heals. If the area remains scabby or itchy, apply vaseline daily to keep it moist and reduce itchiness.
6. If the site develops increasing redness, pain, or pus/malodorous discharge, these changes may be signs of infection. Please call the office (704-230-1302) as soon as possible or seek medical care.
7. If you notice bleeding through the bandage, hold pressure with gauze/cotton/cloth continuously for 15 minutes without peeking. If bleeding continues, hold pressure for another 15 minutes. If bleeding persists, please call Dr. Al-Dabagh or go to the nearest emergency room.

NOTE: Do not take any blood thinners (other than those prescribed by your doctor) including aspirin (or aspirin-containing medications). If you need pain relief, take Extra Strength Tylenol. Postoperative pain should improve considerably after 2 to 3 days.

If you have any concerns please give us a call at (904)544-5800. After clinic hours, our line will have an option for urgent concerns, which will route directly to Dr. Al-Dabagh’s cell phone.

We will return your calls as soon as possible. If you are experiencing a life-threatening event, please call 911 or seek help at the nearest emergency department.

Pre-Op Nail Biopsy Care

Prior to your nail biopsy:

1. Purchase all your bandage materials. These can be found at your local drug store:

   -Nonstick dressing pads

   -Bandage or surgical tape

   -Epsom Salt

   -Chlorhexidine 4% cleanser (Hibiclens)

   -Mupirocin ointment

   -Basin to soak your foot or hand

2. Do not smoke for a week before and after the biopsy as it will delay wound healing and increases complications.
3. During the 3 days before surgery, clean your hand or foot in the morning and evening. Perform a 5 minute hand or foot scrub with warm water and chlorhexidine soap (Hibiclens) to remove dirt from under the nail margin and crevices of the nail folds.
4. Cut your nails and remove all nail polish.

For a toenail biopsy:

• Prepare loose-fitting or open-toe shoes to wear after the procedure.
• Bring someone who can drive you home after your appointment.
• Inform the office if you are taking a blood thinner / anticoagulant medication or need to pre-medicate with antibiotics prior to the procedure.
• Please eat and take all medications prescribed by your primary physician, especially blood pressure medications.

On the day of surgery and afterwards:

1. Due to the local anesthesia, it is normal for the affected area to feel numb for 1 to 2 hours after your procedure.
2. Leave the bandage on for 24 hours after your procedure. Keep the bandage clean and dry.
3. After 24 hours, change the bandage. Follow the wound care instructions carefully.
4. After a toenail biopsy, avoid wearing tight shoes for 1 to 2 weeks.
5. Do not participate in strenuous exercise or lift more than 5 pounds for 2 weeks after your procedure.
6. It can take about 6 months to 1 year for a nail to regrow.

Nail Biopsy Wound Care

Please wash your hands thoroughly before caring for the nail biopsy wound.

PLEASE DO THE FOLLOWING:

1. Leave the pressure-dressing (applied at the office) on for 24 hours.
2. After 24 hours, you may soak the bandage in warm water to help remove it.
3. Elevate your hand or foot as much as possible to minimize pain and bleeding.
4. Do not participate in strenuous exercise or lift more than 5 pounds for 2 weeks after your procedure.
5. After a toenail biopsy, wear loose-fitting shoes for 1-2 weeks to allow room for a bandage and minimize pressure and trauma to the healing wound.
6. Keep the bandage dry. Cover with a plastic bag to shower.
7. If you are prescribed oral antibiotics, please finish the full course.
8. It can take about 6 months to 1 year for a nail to regrow.

Cleaning and Caring for Your Wound

1. Wash your hands thoroughly before caring for your wound.
2. Soak affected finger or toe in warm Epsom Salts (1 tablespoon per quart) for 15 minutes twice daily for the first week, and once daily thereafter.
3. After soaking, apply mupirocin ointment to the wound and cover it with a new, clean, non-stick bandage or dressing.
4. Keep the tip of the finger or toe open to the air to check for discoloration or redness.

Managing Side Effects

You may have throbbing, pain, swelling, bleeding, drainage, or sensitivity in your affected finger or toe after the biopsy. Follow these guidelines to help with side effects:

• Keep affected hand or foot elevated (raised above the heart level). This will help decrease pain and swelling. ​
• Discomfort may begin as soon as one hour after the procedure. You can take acetaminophen (Tylenol) to help with pain and or discomfort. Avoid taking aspirin or nonsteroidal anti-inflammatory drugs (such as Ibuprofen, Advil, Naproxen, or Aleve). These medications may increase bleeding.
• Using a cold dry compress (ice pack) can help with pain, discomfort and swelling. Place an ice pack on your wound over the dressing for 15 to 20 minutes every hour, as needed.
• If you have bleeding, press firmly on the wound with a clean gauze pad for 20 minutes. If the bleeding does not resolve, please call the office at (704) 230-1302.

Please call our office if you have:

• A temperature of 100.4 or higher
• Chills
• Any of the following symptoms within your wound or surrounding area:
• Increased redness or swelling at the tip of your finger or toe
• Increased pain or discomfort
• Your skin feels hard, warm, or hot to the touch
• Yellow or green drainage
• Foul odor
• Bleeding that doesn’t stop after applying pressure
• Blue or purple discoloration of the tip of your finger or toe

If you have any concerns please give Dr. Al-Dabagh a call at (904)544-5800. After clinic hours, our line will have an option for urgent concerns, which will route directly to Dr. Al-Dabagh’s cell phone.

We will return your calls as soon as possible. If you are experiencing a life-threating event, please call 911 or seek help at the nearest emergency department.

Nylon/Prolene Suture Instructions

*Please wash your hands thoroughly before caring for the wound.

PLEASE DO THE FOLLOWING:

1. Leave the pressure-dressing on the wound and keep it dry for the first 48 hours.
2. After two days have passed, slowly and carefully remove the dressing so that the underlying sutures are not pulled apart.
3. After removing the dressing, the sutured area should be washed once a day with hydrogen peroxide. Apply Vaseline with a clean Q-tip and then cover with a Band-Aid or other form of non-adherent dressing.
4. Do not allow the wound to be left open to dry or become dry enough to form a scab. For your wound to heal properly with the best cosmetic outcome, it is important to keep the wound moist with Vaseline and covered at all times.
5. If the wound appears to be drying out, apply more Vaseline with each dressing change. Continue this routine until the sutures are removed.
6. If the site develops increasing redness, pain, or pus/malodorous discharge, these changes may be signs of infection. Please call the office as soon as possible or seek medical care.
7. If you notice bleeding through the bandage, hold pressure with gauze/cotton/cloth for 15 minutes continuously without releasing. If bleeding continues, repeat and hold pressure for another 15 minutes. If bleeding persists, please call Dr. Al-Dabagh or go to the nearest emergency room.

NOTE: Do not take any blood thinners (other than those prescribed by your doctor) including aspirin (or aspirin-containing medications), Ibuprofen, Aleve, Advil, or Naproxen. If you need pain relief, take Extra-Strength Tylenol. Postoperative pain should improve considerably after 2 to 3 days.

If you have any concerns please give us a call at (904)544-5800. After clinic hours, our line will have an option for urgent concerns, which will route directly to Dr. Al-Dabagh’s cell phone.

We will return your calls as soon as possible. If you are experiencing a life-threatening event, please call 911 or seek help at the nearest emergency department.

Open Wound Care

Please wash your hands thoroughly before caring for the wound.

PLEASE DO THE FOLLOWING:

1. Leave the pressure-dressing over the wound and keep it dry for the first 48 hours.
2. After 2 days pass, remove the dressing carefully.
3. After the dressing is removed, wash the wound every day with hydrogen peroxide. Please be gentle with the fresh wound. Do not attempt to remove any debris that does not come off easily. Small spots of bleeding are common when cleaning your wound.
4. Coat with Vaseline using a clean Q-tip and then cover with a Band-Aid or other form of non-adherent dressing.
5. Do not allow the wound to be left open to dry or become dry enough to form a scab. For your wound to heal properly with the best cosmetic outcome, it is important to keep the wound moist with Vaseline and covered at all times.
6. If the wound appears to be drying out, apply more Vaseline at each dressing change.
7. Continue these instructions until brand-new pink skin forms over the wound. This process may take 4-12 weeks, depending on the size of the wound, the location, and how well you heal.
8. If the site develops increasing redness, pain, or pus/malodorous discharge, these changes may be signs of infection. Please call the office as soon as possible or seek medical care.
9. If you notice bleeding through the bandage, hold pressure with gauze/cotton/cloth for 15 minutes continuously without releasing. If bleeding continues, repeat and hold pressure for another 15 min. If bleeding persists, please call Dr. Al-Dabagh or go to the nearest emergency room.

NOTE: Do not take any blood thinners (other than those prescribed by your doctor) including Aspirin (or aspirin-containing medications), Ibuprofen, Aleve, Advil, or Naproxen. If you need pain relief, take Extra Strength Tylenol. Postoperative pain should improve considerably after 2 to 3 days.

If you have any concerns please give Dr. Al-Dabagh a call at (904)544-5800. After clinic hours, our line will have an option for urgent concerns, which will route directly to Dr. Al-Dabagh’s cell phone.

We will return your calls as soon as possible. If you are experiencing a life-threatening event, please call 911 or seek help at the nearest emergency department.

Skin Graft Care

Please wash hands thoroughly before caring for your wounds.

PLEASE DO THE FOLLOWING:

Leave the two pressure-dressings over both graft and donor sites for 48 hours. Do not get them wet. After 48 hours, you may carefully remove these pressure-dressings.

GRAFT SITE: Under the pressure-dressing, you will see a non-adherent dressing and the fragile graft. After removing the dressing, wash the graft gently with hydrogen peroxide. Reapply Vaseline and cover the graft with a new Band-Aid or other non-adherent dressing. Never allow the graft to dry out. Avoid submerging the graft in water (showering, washing, pool).

For the next week, it is normal for the graft to change color (deep purple) and also to swell. However, if it starts to emit a foul odor, discharge pus, or become crusted, hard, and black, then please contact the office as soon as possible.

DONOR SITE: After removing the pressure-dressing, you will treat the DONOR site according to the type of repair. Typically, the donor site is left to heal on its own.

Please follow the instructions below:

• Wound healing on its own: After 48 hours, wash the area daily using a clean cotton ball and hydrogen peroxide. Then apply Vaseline and re-dress with a new non-adherent bandage daily until the wound completely heals. You will have brand-new pink skin covering the wound. Never allow the wound to dry out or form a scab during this time.
• Dissolvable sutures: You will receive separate instructions for this type of repair.
• Non-dissolvable sutures: You will receive separate instructions for this type of repair.

NOTE: Unless prescribed by your doctor, do not take any blood thinners including Aspirin (or aspirin-containing medications), Ibuprofen, Advil, Aleve, or Naproxen. If you need pain relief, take Extra Strength Tylenol. Postoperative pain should improve considerably after 2 to 3 days.

If you have any concerns please give Dr. Al-Dabagh a call at (904) 544-5800. After clinic hours, our line will have an option for urgent concerns, which will route directly to Dr. Al-Dabagh’s cell phone.

We will return your calls as soon as possible. If you are experiencing a life-threatening event, please call 911 or seek help at the nearest emergency department.