After Cardiac Surgery

Looking after your surgical wounds

This information has been prepared to help you and your relatives understand more about your heart operation and how to take care of your wounds. It also gives you general information about wound care and some practical advice on what to do if you have any signs and symptoms of infection and how this is to be reported.
Chest Sternum During surgery the sternum (the bony plate of the ribcage) is cut and opened. After surgery this is then closed and held firmly together with sternal (steel) wires. Dissolving sutures (stitches) are then used to sew the skin layers back together. Once your dressing is removed therefore, you will not see any stitches. Occasionally, stronger stitches are used on the skin in addition to the dissolving sutures and these will be visible when your dressing is removed. These are usually removed 10 days after your surgery, either in hospital, or at home by the District Nurse. Legs / Arms (Coronary Artery Bypass Graft patients only) Incisions made to remove either an artery from your arm, or more commonly a vein from your leg, are sewn back together in the same way as the skin layers of your chest wound, using dissolving stitches. Once the dressing is removed, there are no visible stitches. Occasionally stronger stitches may be used (particularly on leg wounds) to help close the wound. These will be visible and will need removing around 10 days after your surgery. The Healing Process The skin layers will begin to heal very quickly and top layers are usually healed sufficiently within 48 hours to allow you to take a shower. They will continue to heal across the full depth of the wound for at least 6 weeks. The bones will take much longer to heal, up to 6 months or more, slowly knitting back together. Looking after your wounds Your wounds will heal completely over a period of months but in the event of disruption in wound healing, the following practical advice must be followed. If you have any leakage from the wound when you leave hospital, a District Nurse visit will be arranged to come and dress the wounds as required. If your wounds are clean and dry when you go home from hospital, you will not be referred to the District Nurse. It is therefore vitally important that you look after your surgical wounds once you get home, and observe them daily for any signs or symptoms of disruption to the healing process. Signs and Symptoms that require reporting: Increased pain as the wounds heal the pain should steadily decrease, so any increase in pain or new pain should be reported immediately Leakage any new discharge (not already dressed by District Nurses) should be reported immediately Increased redness / tenderness the skin around the wound edges should be healthy in appearance; any changes should be reported immediately `Clicky` sternum the ribcage and sternum move up and down as you breathe. Any noticeable `clicking` of the sternum should be reported immediately

Editorial Board No: 0896/09 Issue date: Dec 2009 Review date: Dec 2011

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You should report symptoms to both your GP and your Cardiac Liaison Nurse here at Wythenshawe Hospital.

Wythenshawe Cardiac Liaison Nurses (Monday Friday 8am 4pm) - 0161 291 5067 (Outside these times and Bank Holidays you may leave a message on the answer phone). Ward F6, Wythenshawe Hospital - 0161 291 2566/2563
General care of your wounds: Ladies Wearing a bra will help reduce the pressure on the chest wound. A surgical pad or some gauze can be fitted under the bra to minimise discomfort across the wound. Hygiene Keep your surgical wounds clean by washing them daily. It is better to have a shower than a bath, as a shower will wash away germs. Avoid strong perfumed soaps as they can cause irritation a mild soap is fine and will act as a mild antiseptic. Do not use flannels or sponges on wounds as they can harbour bacteria and can actually infect wounds. Use either your hand or a disposable cloth to wash the wound. Ensure towels and clothing are washed and changed regularly. Hand washing avoid touching your wounds as much as possible. If you do need to touch your wound make sure you wash your hands first and then again afterwards, to avoid contamination. Thrombo embolytic (TED) Stockings These stockings are worn to reduce the risk of you developing a blood clot after your surgery and for the 6 weeks post surgery during your period of convalescence. These need to be changed and washed regularly. They can be removed at night as your legs will be elevated in bed. Make sure these stockings are pulled up correctly as areas where the stockings `bunch up` will put pressure on your legs and may cause an indentation (sunken ridge) where the stockings put pressure on the soft tissues. Eat Well Your wounds have increased your dietary requirements in the short term, as the healing wound needs lots of nutrients for healing to take place. Diabetic patients must ensure blood sugars are well controlled during this healing period as research has shown that poor glucose control is linked to delayed wound healing. Gentle Mobilisation During the first 3 months after surgery, it is important that you avoid any activity which places stress upon your healing chest wound. All lifting activities should be restricted to small tasks, for example a kettle of water. Lifting heavier weights such as shopping bags or young children should be avoided during this time. Excessive stress on wounds can lead to traumatic injury and wound breakdown. We hope you will find this a useful guide to caring for your wounds. We have provided some contact numbers below in case you need to get in touch and the key information you will be asked for. Have this leaflet with you when you call.

Key Information:
Consultant Date of surgery Surgery. Date of discharge from hospital

Editorial Board No: 0896/09 Issue date: Dec 2009 Review date: Dec 2011

Version 1