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Primer: Aftercare
DISCLAIMER: The following is for educational purposes only and is not meant as an instructional tool. Any surgical procedures should be undertaken under the supervision and by a medical professional.
So you've had a magnet/prosthesis/implant inserted into your finger/stump/wherever. Wonderful. Now lets make sure it stays there and stays healthy. This primer covers aftercare: how to keep an eye on a surgical site and how to recognise when things have gone wrong. This does NOT cover wound closure and dressings.
WHEN TO REVIEW
We refer to the day of your surgery as "day 0". You should have a MEDICAL PROFESSIONAL (read: GP or family medicine specialist) observe the wound at Day 1, 3 and 7 to make sure it is healing well and there have been no infections or permanent damage to the area. Again this is HIGHLY RECOMMENDED. You may not be able to find a doctor who is willing to partake in your experiments but they will happily review the wound after the fact.
SUTURE REMOVAL
Timing depends on the site:
- Face 3-5 days
- Scalp 7-10
- Arms 7-10
- Torso 10-14
- Legs 10-14
- Dorsum 10-14
- Palm 14-21
WOUND INFECTION
The most important acute complication and the one we want to avoid. More than anything, a surgical site infection will ruin your implant and your day, and more than anything a surgical site infection can be prevented with proper preparation, surgical technique and wound closure (more on that another time).
Wound infection can occur early (due to contamination during procedure) or late (due to a dirty wound). Infection is indicated by the following signs and symptoms
- PAIN: Should decrease as the wound heals
- DEHISCENCE: the wound edges should come together, slowly attach to each other and then "weld" together. A wound that suddenly comes apart may indicate and infection.
- PURULENCE: If your wound is leaking pus its infected
- ERYTHEMA: The edges of your wound will initially be red and inflammed. After all, you cut into your flesh and inserted something that wasn't there before. However, an enlarging red (erythematous) border around the wound indicates something called "cellulitis", which is an infection of the skin. This needs to be seen IMMEDIATELY, as it can very rapidly cause deteriorate
VASCULAR SUPPLY
Blood vessels are everywhere in the body and your tissues depends on them for nourishment. Even a small surgery (say, at the end of your finger) can disrupt the small arterioles and result in tissue damage. We can test the vascular supply to the surgical site by testing whether the tissue "blanches".
Press on an area of your skin on your arm and hold your finger down for a while. When you take your finger off the tissue has turned white - Blanched. This represents you pushing the blood out of the tissue, making it appear pale. When you release the pressure the tissue quickly turns pink again as blood rapidly returns to the pallorous area.
The time the tissue takes to return to pink is termed "Capillary Refill" and is a quick measure of vascularisation to the area. Capillary refill should remain below 2 seconds.
SENSATION
You have the ability to sense multiple things at your fingertips; don't believe what you hear you have far more than 5 sense. There is fine touch, pain, vibration, proprioception and others at your fingertips. However fine touch discrimination is more than adequate for out purposes.
I have seen a lot of anecdotal reports saying that people have lost some sensation in their fingertips following magnet impantation. Just to clarify, if you use lidocaine as a local anaesthetic the numbness should last no longer than 24 hours. Please be aware if you are trying to shove a magnet into the end of your finger there is a high chance you will cause some sort of nervous injury.
Fine touch is your ability to discriminate small, non-painful stimuli from each other when they are touching your skin. This can be done using a cotton-tip or even the corner of a piece of tissue paper. For a finger you could try lightly touching the cotton-tip against either side of your patient's finger to test if their fine touch remains intact. If it does not you should seek medical advice.
Comments
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Something I'd like to add here is inflammation. Inflammation is a natural response to a procedure marked by 5 cardinal signs which can overlap with some of the above mentioned. Something which can occur particularly in fingertips is that inflammation becomes bad enough to kill local tissue. Undermining inevitably destroys some vasculature. In finger tips it's the smallest vessels capillaries that we're talking about. If inflammation is great enough, tissue will die. This tissue then inevitably becomes infected.
Prevention of inflammation is one of the more important aftercare measures. This is specific to areas with poor circulate such as finger and ears etc. Many have found that periodically icing the site and taking ibuprofen regularly can prevent inflammation and many artists advice these steps as part of aftercare. Overuse of ice can damage the issue and ibuprofen has its side effects.
Some also use preprocedural antibiotics. This is a step I consider to be overkill for a finger; however, if people ever move to large and more invasive types of Jewelry it may be an important intervention. This is of course something to should discuss with a physician as improper use can be worse then a local infection.
