CRYOSURGERY
PRE OP INSTRUCTIONS | ACTIVITIES |
BANDAGE MATERIALS | SUTURE REMOVAL
POST OP INSTRUCTIONS | COMPLICATIONS |
CHANGING OF THE DRESSING | LONG TERM HEALING
Nitrogen comprises 80% of the air we breathe. Liquid nitrogen is at a temperature of -321 degrees Fahrenheit or -196 degrees centigrade, a point at which it is no longer a gas but a clear, odorless liquid.
Liquid nitrogen is used in controlled fashion to create frostbite in unwanted growths, both benign and pre-malignant. Some medical doctors also treat cancer, using probes to monitor the depth of freezing.
As liquid nitrogen is much colder than anything found in nature, the body perceives it as a hot, stinging sensation which is mildly to moderately uncomfortable, depending on the location being treated and the length of application. Usually, anesthetic is not required prior to freezing. If necessary, topical Lidocaine may be applied post-procedure to lessen discomfort.
Immediately post-op, the area treated may itch and develop a hive. Itching usually ceases within an hour only to be followed by a blister which, may have some blood in it.
If this blister is in an area where it is likely to pop, or is cosmetically important, the blister may be opened. The proper way to do this is to cleanse the area and a needle with alcohol and gently prick the top of the blister. Softly express the fluid with clean gauze. After opening, topical antibiotic should be applied. If the blister is in an area of friction, you may want to cover with a band-aid. Do not remove the blister roof as, it acts as a natural dressing. No restrictions on activities, other than what one would take after any minor wound, are required.
The blister roof will usually separate in about a week when on the face. Facial blood supply is so good, injuries heal very quickly. Non- facial locations may take three to four weeks for the blister roof to separate due to differences in circulation.
Pigmentation changes are the only long term complication of cryosurgery, in otherwise healthy individuals. People with Celtic type complexions may have less pigmentation at the treated site while dark complected individuals may have a darker area resulting from the inflammation associated with healing.
It is expected for the areas treated to return to normal texture with no residual palpable changes. If a lesion does not resolve or recurs please contact our office.
Please stop all alternative treatments one week before surgery, as it is unknown what effect these substances may have on bleeding and wound healing.
Garlic, ginkgo, licorice extracts and Vitamin E, at or over 400 units, increase bleeding.
Please stop arthritis type meds such as Advil, Motrin, etc. Tylenol is fine.
Aspirin taken for general purposes should be stopped six days prior to surgery.
If aspirin is taken for prior history of stroke or cardiac events, check with your appropriate doctor to see if it may be stopped four days prior to surgery.
Aspirin may be resumed two days after surgery, if no unusual bleeding has occurred.
Coumadin is not stopped for surgery, as it is given for serious medical problems. However, we need to have an INR no more than one week and no less than 3 days prior to surgery.
Surgery will be cancelled if INR is greater than 3.4.
No strenuous activities for at least 72 hours after surgery. If a flap or graft is performed, no strenuous activities for one to two weeks.
If surgery is on a lower extremity, keep elevated while sitting and minimize standing.
Non-adherent gauze such as Telfa.
Paper tape (gentle on the skin)
Topical antibiotic-Polysporin, Bacitracin, Bactroban, Centany, or Neosporin (about 5% of the population is allergic to Neosporin)
If your surgery is on an extremity, you may be more comfortable with an Ace wrap over your bandage.
In the hair-bearing scalp, a minimum of hair will be shaved and topical antibiotic will be applied to keep the sutures moist two to three times per day-no other dressing required.
If the sutured area is difficult to reach and the assistance at home is limited, you may want to use an extended wear bandage, such as Band-Aid Active Flex- CVS and Target have their own brands. These bandages may be left on 7-10 days and are waterproof. If this type bandage has to be changed, slowly lift the bandage using a toothpick to hold the suture against the skin, as the stitches tend to adhere to the dressing.
Facial sutures-usually removed in 5-8 days
Non-facial sutures-usually removed in 7-14 days
Lower extremities and back- usually removed in 2 weeks
1. No strenuous activities for at least 72 hours.
2. Elevate area as much as possible, if on an extremity.
3. Minimize bending over, if on the head and neck.
4. Change dressing in 24-72 hours. If dressing becomes wet, it needs to be changed.
5. Pain is usually relieved by Tylenol and ice compresses.
1. If the area is bleeding, apply direct pressure to the area and do not release for 15 minutes- use a timer. Call office and continue pressure if bleeding continues.
2. Some pinkness and mild discomfort is normal in the early post-operative period. If the area gets redder and more swollen and accompanied by increasing pain, the site is probably infected and the office should be called. Some pinkness/redness is normal around each suture as it gets closer to the suture removal time. The incision itself is usually not red. This reaction to the sutures is minimized by keeping the area covered.
3. Swelling-Gravity will determine where the majority of swelling occurs. Swelling may be prominent in the eyelid area as the skin is loosely attached. Swelling is usually most obvious upon awakening, when the surgery is in the eyelid area. Swelling may impede healing, particularly on the lower legs. Swelling may be reduced by cold compresses, elevation, and compression with an Ace wrap, if appropriate.
4. Hematoma-A hematoma is caused by bleeding underneath the suture site. Evidence of a hematoma is rapid swelling and distension of the surgical site usually in the first few hours after surgery is performed. The office should be called, so the collection of blood may be released.
TYPICAL SUPPLIES- 1) Topical antibiotic such as Polysporin, Neosporin, Bacitracin, Bactroban or Centany. 2) Non-stick gauze, such as Telfa. 3) Paper tape, 4) Hydrogen peroxide. Optional: Wound wash saline (saline in a pressurized can, available at most pharmacies) and Ace wrap.
ALTERNATIVE SUPPLIES- This would be used in hard to reach areas with limited at-home assistance. It would include the multi-day use bandages such as the Band-Aid Active Flex, along with CVS and Target’s own brands, and hydrogen peroxide.
TYPICAL DRESSING CHANGE: Initial dressing change at 24-72 hours and subsequent dressing change when bathing, or at least every 48 hours. Keep area dry until time to change the dressing. The dressing applied in the office will be big and bulky, as it is a pressure dressing to decrease the chance of bleeding. Soaking the dressing in the shower will help to loosen it, so it is easier to remove. Wash the area gently with soap and water. Any dried blood can be loosened with hydrogen peroxide. If material cannot be easily removed, don't force it. Hydrogen peroxide does not need to be used if there is no adherent material. Wound wash saline may be helpful to cleanse the area.
Dry the area: Apply thin film of antibiotic.
Apply non-stick gauze trimmed to just cover the excision and sutures.
Apply paper tape.
Apply Ace wrap if appropriate.
ALTERNATIVE DRESSING CHANGE:
Change dressing at 48 to 72 hours. Will require assistance for this dressing change.
Cleanse the area as above, then dry the area and apply the multi-day use bandage with the sutured incision centered underneath the bandage. This dressing may be left in place for 7-10 days. If it becomes loose, it will need to be changed. To change, the bandage must be lifted slowly and a toothpick is used to hold the suture down against the skin, as the suture will be entrapped in the bandage material. Holding the suture down, the dressing is slowly removed. The area may then be gently washed, dried and a multi-day use bandage reapplied. We will remove the last dressing in the office when we remove the sutures.
Keep appointed suture removal time in the office.
The sutures will be removed and steri-strips will be applied to the sutured site.
No further care needs to be done unless instructed otherwise. The steri-strips may be removed in one week if they have not fallen off prior to this time.
Incisions on the face usually heal very well without raised scars; however, procedures done on the upper torso and shoulders often go through a phase where the scar will raise up, be pink, a little itchy and sensitive for several months. Usually, this raised scar will resolve on its own. However, if it is very symptomatic, a cortisone injection may be used to hasten this process. The healing period occurs very actively over the first six months postoperatively and then much more slowly over the next 18 months. Generally, scars will be pink, when they are new, and white when they are old. Every attempt will be made to place the incisions in natural skin lines, if possible. The only postoperative care which seems to help scars be less noticeable is to keep them covered. It probably does not matter too much what substances are used to keep them covered, just keeping them covered works. Many silicone dressings are made for this purpose. Mederma is an over-the-counter product, which is an extract of onion that is promoted for minimizing wounds. There is minimal scientific evidence to support this product; however, the massaging of the area as the Mederma is applied may be helpful for some raised scars. It would not be necessary in flat scars. Vitamin E products on freshly healed skin are often irritating and should be avoided. In particular, there are quite a few cases of irritation from pricking a vitamin E capsule and applying it directly to the wound, so this is discouraged.