SURGERY PREP FOR SURGERY ON THE LEG

We will be prescribing mupirocin ointment for you to use twice a day inside your nostrils for 5 days leading up to the surgery date--this will cut down on the possibility of Staphylococcal bacterial infection after the surgery (people can carry Staphylococcus inside their nostrils). 

You will need to cleanse your whole body with Hibiclens soap (available over-the-counter) 5 days leading up to the surgery day and the morning before the surgery (please especially scrub all folds of your skin such as armpits, groin, under the breasts/stomach-even between your toes!). 

For after the surgery, please purchase: 

Compression stocking 20-30mmHg (available at medical supply stores or online, ask the pharmacist for help if you cannot find it; make sure it is 20-30mmHg). 

Non-stick pads (Curad brand or Telfa brand are some good ones); buy the ones that are about the size of an iPhone. 

Coban wrap (a wrap to put over the non-stick pads that sticks to itself).

MEDICATION/SUPPLEMENTS & BLEEDING

Many medications (both prescription and non-prescription) can inhibit the blood's ability to clot and may increase the tendency to bleed during surgery and the post-operative period. Many of these medications are anti-arthritic, anti-rheumatoid, anticoagulant or circulation medications. Most of these medications contain aspirin or ibuprofen.

Please contact your primary physician prior to discontinuing any PRESCRIPTION or OVER-THE-COUNTER DOCTOR ORDERED medication (i.e. coumadin, aspirin). Inform your doctor of your scheduled surgery and ask if and when to stop your medication. He/she may also inform you when to resume the medication post-op.

If you are taking any vitamins or supplements (fish oil, garlic, etc.) or non-prescription medications that were not ordered by a doctor (i.e. aspirin, or other-over the-counter anti-inflammatory medications) that may increase your tendency to bleed, we would like you to discontinue them 2 weeks prior to your surgery.

The following is a list of common medications that increase your tendency to bleed:

Advil (Ibuprofen)


Alcohol


Aleve (naproxen)


Alka Seltzer


Anacin


Anaprox (naproxen)


Ascriptin
Aspirin
B.A.C. (butalbital / aspirin / caffeine)


Buffer Cataflam (diclofenac / potassium)


Children's Aspirin
Clinoril (sulindac)


Cogesprin
Coumadin (warfarin)


Daypro (oxaprozin)


Diorinal (butalbital / aspirin / caffeine)


Disalcid (salsalate)


Doan's Pills
Dolene (propoxyphene / aspirin / caffeine)

Dolobid (diflunisal)


Doraphen Compound (propoxyphene / aspirin / caffeine)


Doxaphene Compound (propoxyphene / aspirin / caffeine)


Dristan


Easprin


Ecotrin


Empirin


Excedrin
Feldene (piroxicam)


Fiorinal (butalbital / aspirin / caffeine)


Fiortal Caps (butalbital / aspirin / caffeine)


Four-Way Cold Tabs
Halfprin (aspirin)


Ibuprofen


Indocin (indomethacin)


Iodine (etodolac)


Isollyl Improved (butalbital / aspirin / caffeine)


Lortab ASA (hydrocodone / aspirin)


Marnal (butalbital / aspirin / caffeine)


Meclome (meclofenamate)

Medipren (ibuprofen)


Midol
Mono-Gesic (salsalate)


Motrin (ibuprofen)


Nalfon (fenoprofen)


Naprelan (naproxen)


Naprosyn (naproxen)


Naprosyn (naproxen)


Norgesic (orphenadrine / aspirin / caffeine)


Nuprin (ibuprofen)


Ordis (ketoprofen)


Oruvail (ketoprofen)


Pamprin IB (ibuprofen)


Panwarfin (warfarin)


Percodan (oxycodone / aspirin)


Percodan-Demi (oxycodone / aspirin)


Persantine (dipyridamole)


Plavix Tabs (clopidogrel bisulfate)


Ponstel (mefenamic acid)


Relafen (nabumetone)


Robaxisal (aspirin / methocarbamol)


Roxiprin (oxycodone / aspirin)


Salflex (salsalate)


Sine Aid
Sine Off
Soma Compound (aspirin / carisoprodol)


Talwin Compound (aspirin / pentazocine)


Tegretol (carbamazepine)


Ticlid (ticlopidine)


Tolectin (tolmetin)


Toradol (ketorolac)


Trental (pentoxifylline)


Trigesic (acetaminophen / aspirin / caffeine)


Trilisate (choline / magnesium / trisalicylate)


Vanquish (butalbital / aspirin / caffeine)


Vitamin E Supplements


Voltaren (diclofenac)


Warfarin


Zorprin (aspirin)

• Please SHOWER and EAT before your surgery!

• Please do not drink any alcoholic beverages for 12 hours prior to your surgery. Alcohol causes blood vessels to dilate and could aggravate bleeding problems. It is a good idea to bring a laptop, book or magazine with you on the day of surgery. General excisions typically take an hour. The Mohs procedure may take a full day, much of which you will spend in the waiting room. During this time your removed tissue will be processed in our laboratory and examined by your physician/ surgeon under the microscope in our Mohs laboratory. 

THE DAY OF THE SURGERY 

Please note that you might need to have someone drive you home from the procedure, depending on the location of the lesion (i.e, near the eye) and / or medications that might be required. 

When you arrive for surgery, the surgical assistant will take you to the surgery suite and prepare the involved area of the skin for surgery. If you have any additional questions, feel free to ask them. The physician surgeon will also see you at this time and review your case. 

The area of skin (tissue) containing cancer will then be anesthetized with a local anesthetic. It usually takes a few minutes to anesthetize the involved area. The surgeon will then remove the cancerous area. After the tissue has been removed, the bleeding will be stopped with a cauterizing machine, which generates heat. Before you leave the surgical suite, the surgical assistant will cover your wound with a bandage. The tissue will be sent to the laboratory for examination. 

It will then take approximately two to three hours to prepare the tissue for microscopic examination. If examination of the tissue removed reveals that your tissue still contains cancer cells, the procedure will be repeated. Several excisions and microscopic exams may be done in one day. It is seldom necessary for you to return the following day for additional surgery. The average number of surgical sessions for most skin cancers is two to three. 

THE SURGICAL WOUND 

When the skin cancer has been completely removed, a decision is made on the best method for treating the wound created by the surgery. The methods include: 

1. Closing the wound directly with stitches (sutures); 

2. Letting the wound heal by itself (granulation); 

3. Closing the wound with a skin graft or flap. 

We will recommend which of these methods will be best for your individual case. Repairs may be completed by us or by other surgical specialists. Each patient is unique and we must individualize your treatment to achieve the best results. 

You may experience a sensation of tightness (or drawing) as the wound heals, and this is normal. As time progresses, you will feel this less and less. On occasion, skin cancers involve nerves and it may be one or two years before your sensation returns to normal. In some cases, the numbness may be permanent. Any form of surgery will leave a scar. The Mohs procedure tends to minimize this as much as possible. Mohs surgeons try to remove only those tissues involved with cancer and preserve as much normal tissue as possible. We make every effort to obtain the optimal cosmetic results for you and work in conjunction with other surgical specialists in the field of cosmetic and cutaneous surgery. 

The new skin that grows over the wound may contain many more blood vessels than the skin that was removed. This results in a red scar and the area may be sensitive to temperature changes. This sensitivity improves with time and the redness gradually fades. If you are having a lot of discomfort, avoid extreme temperatures. You may experience itching after your wound is healed because the new skin does not contain as many oil glands. Petroleum jelly will help relieve the itching.

Items needed for wound care: 

1. Aquaphor or a new container of Vaseline

2. Telfa, non stick dressing

3. Paper tape 

4. Q tips

5. Gentle liquid cleanser such as vanicream or cerave or cetaphil.

Wound Care Instructions: 

1. Leave the post operative bandage in place and avoid getting it wet during the first 24-48 hours. 2. Before showering, remove the bandage and discard it.
   

2. Cleanse gently the incision with soap and water just using your clean fingers and avoid any trauma to the incision site.
   

3. Pat the wound dry and apply a generous layer of Aquaphor or Vaseline ointment to the incision. 

4. Cover the wound with a Telfa dressing cut to the shape of the incision and use the paper tape to secure the Telfa dressing in place.
   

5. Repeat this process at least once a day and optimally twice a day. 

General instructions: 

1. When you get home take it easy for 48 hours. No more activity than light walking.
   

2. You may shower at any time after your surgery as long as the bandage/ dressing is kept dry for the first 24-48 hours. If it becomes wet, change the dressing.
   

3. Sleep with head or surgical site elevated using several pillows when possible.
   

4. To optimize healing avoid any smoking for 2 weeks after surgery.
   

5. Please refrain from the following activities for 2-3 weeks after surgery: Heavy lifting over 10 lbs, strenuous exercise like swimming,running, golfing,strenuous housework or yard work.
   

6. It will take 3 months for the incision to be 80% as strong as it was before the procedure. If you feel any pulling or tugging on the incision it is best to stop the activity since it could cause the incision to open up or widen the scar.
   

7. Pain control: Minimize swelling by keeping the operated site elevated as much as possible.  Ice as soon as possible at least 10 minutes on the hour will help the most for pain.
   

   • A gentle ice pack to the area like some frozen peas can help with the swelling especially the first 2-3 days. 10 minutes on and 10 minutes off maximum. It can be applied directly to the dressing or just below the incision.
     

   • You can use Tylenol extra strength 2 tablets every 6-8 hours for pain control and if you need to you can add Advil/Motrin 200 mg 2-3 tablets every 8 hours.
     

1. If your procedure is on the lower leg, it is very important that you clean the wound twice a day with soap and water or Hibiclens solution and apply the Aquaphor or Vaseline. Keep the leg elevated as much as possible for the first 7-10 days and utilize a compression stocking if instructed.

2. It is not unusual to have some minimal bleeding after the procedure. If you notice active bleeding, apply direct pressure to the dressing for 20 minutes then monitor. If it still is bleeding, reapply the pressure again with an ice pack for 20 minutes. It should stop by then. If not, call our office directly or go to the emergency room or urgent care if the bleeding does not stop.

   Products such as woundseal and bleedstop can be found over the counter and may help as well.
   

3. Monitor for infection such as increasing redness, swelling, pain, drainage, fever etc. Call our office and take photos if you notice any of the signs of infection.
   

4. Any treatment for skin cancer will leave a scar. It is important to know that the scar will evolve over 8-12 months. It is important to minimize direct sun exposure on the healing incision, therefore it is good practice to put daily sunscreen on the incision beginning 2 weeks after the procedure and a moisturizing lotion on at night since direct sunlight can cause a darkening of the scar line or persistent redness. If you have a history of abnormal scarring, such as hypertrophic scars or keloids, or if there are any problems with the healing of the scar, we have treatments to optimize the result. 

Everyone heals differently and the final scar appearance depends greatly upon the individual's ability to heal.