76: Post-Op Dresssings - Yoho

Question 1

Answer 1

bandage scissors (not the black ones)

• always use the proper tool for the job
• Other materials:
  
  • non-adherent mesh
    
    • lay over wound, put sterile gauze on top of this
    • helps get the dressing off
  • sterile gauze
  • gauze roll
  • paper tape
    
    • may choose this if person has allergies to adhesives
  • ace/elastic badage
  • bandage scissors

Question 2

purpose of dressings

Answer 2

• keep the area clean (infection control)
  
  • takes 3 days for epithelization
    
    • plastic surgery will take out sutures at 3 days
  • need to achieve 30% tensile strength (keep sutures in until then)
    
    • keep in 10-14 days (really 17 days - dont keep them in that long )
    • afterwards we apply steristrips (holds the epidermis together)
• maintain the correction (alignment)
  
  • no additional correction
• compression (swelling reduction)
  
  • reduce swelling
• absorb bleeding, etc.

Question 3

notes from the video

(rewatch online)

Answer 3

• purpose: to maintain the correction, but can undo the correction if done incorrect
• make curved incisions rather than linear to reduce contraction and make it closer to relaxed skin tension lines
  
  • make hatch lines, match them up in suturing to ensure proper alignment
• Bunion Post-op
  
  • adaptic down first
  • 4X4 gauze, make a cut into 1/3 and 2/3 to wrap around toe. add additonal gauze dorsally
  • roll bandage around forefoot medial to lateral, keeping scissors in hand, half wrap around toe
  • plantarflex, invert and adduct at MPJ to hold toe straight
  • tape to hold down, stockinette over it all, can add ACE bandage
  • remove with scissors from plantar side
  • dressing change 3-4 days, then at a week sutures out and new dressing with steri strips
• Taylor’s bunion Post-op
  
  • 3x3 guaze, cut through 3/4 way for toe wrap. add another gauze dorsally
  • 3 inch cling starting lateral to medial, half wrap around toe, tuck up toe near 4th with wrap
  • tape finish, stockinette, add ACE bandage
  • if putting tape on skin, use paper tape
  • remove with scissors plantarlly
• Hammertoe Post-Op dressing
  
  • unroll and fold a 4 x 4 in half, wrap around toe with free edges medial and lateral
  • add gauze dorsally
  • 3 in cling starting dorsally medial -> plantar -> lateral
  • half wrap around each affected toe
  • reverse direction of taping to balance forces on toes, going around each again
  • remove dressing along medial side of foot
• P&A post-Op
  
  • total nail = need adaptic, partial does not
  • 2in or 1 inch
  • wrap medial to lateral (for lateral nail removal), reverse for removal on other side of nail. trying to allow good drainage. doesn’t matter direction if total nail removal
  • small coban to hold, toe sock, coban wrap again in good direction

Question 4

complications from dressings

Answer 4

• vascular compromise
  
  • too tight dressing
  • can lead to dehiscence
• cause alignment problems
• wound dehiscence
  
  • influenced by the dependent position of the foot increasing tension on sutures
• increased inflammatory response
  
  • if its too tight