plastic surgery (DOC)

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					  Your guide to plastic surgery




Author: Daren Edwards, Clinical Nurse
Specialist

Contact details:
Department of Plastic Surgery
2nd floor John Harrison House
The Royal London Hospital
London
E1 1BB

Wards
Bedford Fenwick ward – 020 7601 7070
Henry Butlin ward – 0207 601 7070

Publication date: October 2006
Reference: BLT/PTINFO/082

Barts and The London NHS Trust
Switchboard: 020 7377 7000              1
www.bartsandthelondon.nhs.uk
Introduction
This is a short guide to give you an understanding of plastic surgery at Barts and the
London NHS Trust. It is a short explanation of what you can expect and to help you
to understand some of the risks and benefits of your surgery.

Please also note that you will be seen by a Plastic Surgeon at a pre-assessment
clinic before you are admitted to hospital for your operation. This is a time for you to
discuss with the surgeon any risks associated with your surgery and what advice you
should follow.

It is therefore very important that you keep any appointments with the hospital
for your pre-assessment and any appointments after your operation.

Each year, our surgeons carry out many types of plastic surgery operations and each
operation can differ from others. The surgeons will explain to you what type of
surgery is proposed, so that you have a full explanation to help you make an
informed decision and consent to the operation.

The Plastic Surgery Department aims to make your hospital stay as pleasant as
possible and we would welcome any comments you have about our service.


On the day of your operation
To help reduce the spread of infection, we will ask you to remove any jewellery,
make-up and nail varnish before your operation. Items such as rings can be taped
over. If you are having any operation to your hand, your rings and other items of
jewellery on your hand must be removed.


After your surgery
After your surgery and before you are discharged from hospital, you will be given
instructions on what you need to do when you go home. These instructions should be
followed as closely as possible. You will also be given an appointment to come back
to the dressing clinic where your wounds will be assessed and treated accordingly by
the nursing staff, or to be seen at home by the District Nurse.

You may also receive an appointment in the post to see the Plastic Surgeons a few
weeks later to see how your wound has settled. If you do not receive an appointment
to see the surgeons after your discharge you should notify the nurses in the Plastic
Dressing Clinic.




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Leaving hospital
The Plastic Surgeons have ward rounds every day. When you leave hospital, you
may be given medicines to go home with such as painkillers or antibiotics. If you are
going home the ward nurses will explain to you how and when you should take your
medicine.

Hospital transport is not guaranteed for everyone so you will need to make
arrangements with friends or family to collect you from hospital as soon as you can
and you should arrange for someone to stay with you overnight.


Expectations
It is important that you have realistic expectations about your surgery. You will be
able to make an informed decision about your post operative recovery by discussing
your treatment with the plastic surgeons such as recovering, when you can
recommence activities, and when you can return to work.

After discussions with the surgeons you should be able to understand the
advantages and disadvantages of your surgery and the potential risks such as
infection and breakdown.


Your pre assessment
You will be asked to come into hospital to be assessed by the plastic surgeons
before you have your operation. This is a chance for you to discuss any other
medical problems you have. You should also bring with you any current medication
you are taking from your GP, tell the surgeons any other medical history you have
such as if you are under the care of other doctors or are awaiting test results in
another clinic or hospital. It is important to let your doctor know your complete
medical history including:

      Medications including aspirin and vitamins
      Hormones (oral contraceptives and oestrogen replacement)
      Herbal medications such as St John’s wort
      If you normally take warfarin tablets you may be asked to stop taking
       these three days before your operation.

You may also be asked to have a blood test on the day of your operation.




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What are the risks involved in my operation?
You are more likely to have complications after your surgery if you smoke and/or
drink heavily or if you suffer from the following conditions:

      Diabetes
      High blood pressure
      Obesity
      Asthma or other lung conditions

For instance, if you are overweight your surgeon may not be able to offer you an
operation date and could ask you to reduce your weight so that there is no strain on
your heart post operatively. In this case you may be referred back to your GP for
advice on losing weight and then asked to come back to the pre-assessment clinic at
a later date.
Any health conditions you have should be discussed openly with the plastic surgeon
so that they can help you make an informed decision.


Smoking
Smokers who do choose to have surgery must stop for at least two weeks prior to
surgery or better still give up permanently. If this proves impossible you are asked
to refrain from smoking for at least two weeks after your surgery, to allow your
wounds to heal properly and aid your recovery. If you continue to smoke, you are
much likely to suffer:
     A higher rate of infection
     Wound breakdown
     Skin death
     Anaesthesia complications.

It is also documented in your medical notes if you smoke.


What are the main risks in surgery?

Bleeding is normal with any procedure. However, if there is excessive bleeding, it
can create major complications. If bleeding occurs after your operation it can cause a
haematoma and may require an additional operation to remove it. You can discuss
with the surgeons the type of risk with your operation before you sign your consent
form.

Blood clots in the veins can sometimes be fatal. Longer operating time and general
anaesthesia can increase the risk of a deep vein thrombosis (DVT). This can occur
as a result of a medical condition or from immobilization (which allows the blood to
pool) such as pregnancy, and recovery from surgery. They are difficult to predict. To
help prevent them, during recovery do not stay in one position for too long and flex


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your feet often. Patients who have liposuction in their legs are at higher risk.
Compression garments are worn reduce the risk of DVT.

Infection - the risk of infection is minimal however, antibiotics can reduce this risk
further. If infection does occur, it can be serious. People who smoke, take steroids or
have certain vascular conditions are at greater risk. The longer your surgery lasts
and the more blood you lose, the more likely you are to have an infection.

Chest infection - a chest infection can occur following any general anaesthetic. You
can reduce the risk of this happening by taking regular deep breaths following
surgery and getting up and sitting out of bed as soon as you are well enough. If you
smoke you can reduce the risk of a chest infection by stopping smoking for at least a
month before your operation.


During your stay in hospital
Please try to limit visitors to two at a time. It is understandable that you will have
friends and family who are naturally concerned about you before and after your
operation.

There are, however, other patients who can be very ill and can find a large number of
visitors hard to cope with. Some wards operate a visiting time schedule and the ward
nurses will explain to you and your visitors what times these are.

Telephone calls should be limited to close friends or family only.

The nursing staff have to work within the confines of confidentiality and are not
allowed to give out information to friends. If you have a mobile phone, you may be
asked to make calls in certain areas within the ward or hospital.


Property
You will also be asked to sign a disclaimer for any valuables you bring into hospital.
Barts and the London NHS Trust accept no responsibility for items lost or stolen on
hospital property. You are strongly advised to let your friends or family take any
valuables home.




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Further advice and information can be found at:

Barts and The London’s website:
www.bartsandhtelondon.nhs.uk

Department of Health information about plastic surgery
www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/CosmeticSurgery.

NHS website for general health advice
www.nhsdirect.nhs.uk

The website for the British Association of Plastic, Reconstructive and Aesthetic
Surgeons.
www.bapras.co.uk




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