Dressings
This is how Dr Immerman would like the dressings after your cleft lift procedure
Dressings over the incision itself
The purpose of a dressing over the incision is to absorb any spots of bleeding or drainage so they do not get on your clothes. The elastic shorts that are applied after the operation work well to hold them in place, and very little tape is needed. There is nothing particularly special about these shorts, and if your regular underwear does the job, it is OK to use that instead. Change the dressings once a day for the first 3-5 days, and then if the upper part of the incision is dry, a dressing is not necessary over the Steri-Strips, but if it you find it more comfortable, it is fine to have one in place. Dressings should be removed when showering, and then replaced afterwards. It is OK to shower the day after surgery, but do not soak the incision for any length of time in a tub or pool for one month.
Dressings for the drain
The drain will be taped to the skin using 3″ wide, 3M Durapore tape. Although the drain has a suture holding it in place, this tape prevents any accidental tugging on the tubing from pulling on the stitch and causing pain or accidentally withdrawing the drain itself. It is best to keep the tape that is placed at surgery in place as long as it holds- even when showering. Only replace it if it comes loose. The best way to do this is to tape one piece of tape to the skin, and then lay the drain over the tape, and tape it down with another piece. I recommend 3M Durapore 3″ tape.
A small dressing over the drain insertion site may also be useful from keeping any drainage off your clothes, but is not absolutely necessary.
You will have received instructions regarding drain care at the hospital, along with written instructions.
Note that the amount of drainage can vary greatly, and in some situations there is very little, and in others quite a bit. So, if drainage is low, that is not usually a problem.
About the Black Dot on the Drain
There is a lot of confusion regarding the mysterious black dot on the drain. This dot has two purposes:
1- it helps surgeons position the drain when they are placing it during an operation.
2- it gives a visual indicator if the drain has moved from it’s initial position.
If there is no dot visible, that is not a problem. The drain may have been placed a little farther inside than usual.
If it is farther from the skin than demonstrated in this photo, but the drain is working properly (which usually means the bulb is holding suction and is not quickly filling with air) – then it is not a problem either.
However, if the bulb is quickly filling with air, and the dot has moved a couple of inches away from the skin, that tells us that the drain has accidentally been withdrawn and is no longer functioning properly. If that happens, it is not an emergency – but email Dr Immerman and let him know what is going on.
The gauze tucked by the anus
This is the only part of the dressings that is significant regarding healing. You should use woven gauze, and change it a couple of times a day, plus whenever it gets wet or soiled. This allows air circulation around the lowest part of the incision and absorbs any drainage quickly.
Please keep this kind of gauze tucked in place for one month after the surgery, and longer if there is any bleeding or drainage.
Wet wipes (alcohol-free) are useful for keeping this area clean after bowel movements, and it is OK to shower if you feel that you are not keeping the area clean.
The Steri-Strips
The Steri-Strips add a little additional support to the incision for the first couple of weeks. I would like them removed about two weeks after surgery even if they are still adherent. At that point, they are coming loose, and trap moisture under the loose areas and do more harm than good.
Nail polish remover works well to remove the adhesive from the Steri-Strips, and from any tape.
Activity Instructions
Detailed activity instructions can be found here: https://www.pilonidal.com/activity
Note that sitting is encouraged, and it is OK to sleep in any position that is comfortable.
More Post-Op Instructions
You should have been given several pages of post op instructions at the hospital. Here is a link to those instructions if you have misplaced them, or would prefer to read them online. This link will initiate a download of a PDF with the instructions to your device.
Be sure to start your antibiotics the evening of the operation.