What should I do if I have a painful incision?
The incision for cardiac surgery is usually a median chest incision, or a lateral chest incision, or in the case of valve replacement combined with bypass surgery, an incision in the leg to remove the saphenous vein, etc. It is normal to experience mild redness, numbness, abnormal sensation, swelling, and even pain around the incision after surgery, and these symptoms will gradually disappear as the skin and subcutaneous tissue heal. In the early postoperative period, if there is pain around the incision, you can take painkillers to relieve the symptoms, and you can also take sleeping pills to improve sleep, which have no effect on the healing of the incision.
What is the problem of running water, bleeding and pus from the incision?
If you find that the gauze used to dress the chest incision is soaked with ooze, you should inform your doctor promptly. Sometimes patients and their family members may find clear fluid, bloody fluid or sticky “pus” coming out of the incision.
Generally, 7-9 days after surgery, before the patient is discharged from the hospital, the doctor will check the healing of your incision and remove the stitches. The 7-9 days after the surgery can only determine the initial healing of the incision and cannot ensure that there are no problems later. You will need to keep the incision gauze on for 2-3 days after you go home and it will be removed. If you are worried that the incision scab has not fallen off yet and has not healed, you can go to the nearest hospital to change the medication once every 2-3 days and continue to keep the incision and the surrounding skin clean and dry.
If you sweat a lot, you need to go to the hospital to change the medication and gauze in time, and observe whether there is new redness around the incision, whether there is water, bleeding or pus, etc. Patients who have been postoperative for a long time may also experience the emergence of stitches in the tasty area. In these cases, there is no need to panic and you can contact your supervising physician or go directly to the hospital for examination.
Do not treat the wound yourself to avoid increasing the risk of infection. If the scab has not fallen off yet, do not force it off, just wait for it to fall off naturally. If the incision is uncomfortable with the chest strap, you can wear a body shirt without buttons to reduce the direct friction between the chest strap and the incision.
What is the problem of feeling the bones in the chest “thumping”?
In patients with a median chest incision, the sternum is sawed through the median during surgery and re-secured with wires after surgery. Generally, the sternum can heal completely three to four months after surgery, but older patients or patients with diabetes may take longer to heal. In the early post-operative period, if the patient does not pay enough attention to activities such as supporting the body with one hand, getting up with one hand grasping the bed stall, holding a child, moving furniture or lifting heavy objects, or because of violent and persistent coughing, the originally fixed sternum can be loosened, especially in heavy weight patients. When the patient moves the upper limbs or coughs, the patient will feel a “thumping” sound in front of the chest, which is called “bone rubbing”, and in severe cases, the wire can sever the sternum, resulting in a non-healing incision or even infection, which requires debridement surgery. Therefore, it is very important to actively prevent sternal loosening and cutting in the early post-operative period. So how to prevent it?
The correct coughing method for postoperative patients is that the patient should cover both hands in the forehead when coughing, clench the thorax with both upper arms, and clench the arms hard while coughing. Families can also place the palms of both hands under the patient’s armpits and squeeze the thorax inward, which will reduce the impact of the coughing action on the chest incision.
In addition, when the patient lies down and sits up, a family member must assist. The family member holds the patient’s hands in one hand and places them on the patient’s chest, while the other hand is placed on the lower part of the patient’s neck. In addition, in the early postoperative period, we recommend that the patient wears an elastic chest strap. In the case of a patient with large weight or a violent cough, we recommend using a cotton chest strap and tightening it before patting the back and coughing and when getting up and moving around.
If you have felt the “thumping” sensation described above, you should take extra care. You must strictly limit the movement of your upper limbs and tighten the chest strap so that you can feel the tightness when you inhale in principle, but it will not affect your breathing. You should also inform your supervising physician about your sensations.
What is the lump in the neck above the chest incision? Can it be recovered?
Many patients find that after open-heart surgery, there is a piece of skin underneath the neck just above the incision that will be more prominent, and it feels soft when you press it with your hand, and the pain is not very obvious, which is normal. What is not normal? If you find that the swelling is getting stronger day by day, and the pressure is not soft, but there is a certain tension, like there is water inside, and even painful to the touch, then you need to go to the hospital in time to check. This “bulge” will gradually flatten in most patients, but some people will always be more obvious.
In addition to the area around the incision, why is there pain and discomfort in other areas such as the shoulder, neck, back, chest wall, under the ribs, etc.?
Many patients will find that after the incision becomes less painful, there will be pain and discomfort in the shoulder, neck, back, chest wall and ribs on both sides. These discomforts are mostly related to the patient’s longer passive position during surgery, as well as the damage to the surrounding muscles and soft tissues and rib cartilage caused by the surgical opening of the sternum, and sometimes also related to inappropriate activities and force after surgery.
Patients need to adjust the tightness of the chest belt, sleep posture, reduce the time of bed rest, appropriate indoor walking activities, adjust the mentality and so on. You can also do some local massage and physical therapy, so there is no need to worry too much about it. If the pain affects your sleep, you can take painkillers or sleeping pills to help you sleep. If the pain is uncomfortable for a long time or gradually worsens, you need to go to the hospital in time.
About the pain around the chest incision need to pay attention to the problem: general pain around the incision have: press local pain and sitting and lying for a long time when the chest incision pulling pain, these are normal phenomenon.
What is the reason for the constant stabbing pain in and around the chest incision after surgery?
If you have tingling pain at the incision site, you should first check if there is any problem with the incision healing, such as redness and swelling of the incision, subcutaneous fluid accumulation, or even obvious oozing at the incision. In addition, some sutures may have knots in the knotted area, which may shift towards the skin as it heals, or even come out of the skin, and the patient may experience friction and tingling. Some patients are very thin, which is what we usually call “skin and bones”, and the fixed wire in the chest can be directly touched with the hand, and the wire will also feel like this when it is on the skin.
In addition, in order to increase the safety of the operation, we sometimes install two epicardial temporary pacing leads, which are sewn to the surface of the heart, as needed. Usually we use a special stitching method that helps to pull them out easily after the operation. Most of them can be removed successfully. In some patients, it is difficult to remove the leads due to tissue adhesions when removing the leads.
Since the wires are sewn inside the heart surface, we cannot forcefully pull them out with brute force, which can lead to fatal hemorrhage and pericardial tamponade. In cases like this, we usually cut the wire when it is pulled to its maximum exposed length and leave the remaining portion in the body. The tingling sensation that the patient feels below the chest incision may also be caused by the two wires moving under the skin and irritating it. Sometimes the tingling is so pronounced that the patient needs to go to the hospital where he or she is seen and have the doctor take care of you.
Will the scar be visible after the incision heals? Is there a good technique to avoid it? If the scar is obvious, is there a hospital that can treat it?
In most patients, the scar will not be obvious or uncomfortable after the incision is healed. However, in some patients with keloid, the scar will be very obvious after the incision is healed and will be higher than the surrounding skin, forming a protrusion, and the protruding scar will feel itchy or even painful when it rubs against the clothes. If this happens, try to wear cotton underwear without buttons to reduce the friction, which can sometimes relieve the pain.
In addition, for patients with obvious scar, when they get up after sitting for a long time, they will feel the painful pulling at the incision, which is caused by the sudden pulling of the skin around the scar as it is larger and less elastic. If it is particularly difficult to accept, you can use scar removal drugs or go to a plastic surgery hospital for treatment.
Why do I find stitches coming out of the incision after discharge from the hospital?
Considering the material and tension of the sutures, only the shallowest layer of the skin is covered with absorbable sutures, and the sutures below the skin are not absorbable. This part of the suture may be displaced to the subcutaneous as the tissue heals, especially the knotted part, which may be visible to the skin.
There is no need to worry about this situation, it can be treated promptly at our hospital or local hospital, and it will grow back in 1-2 days. Do not squeeze it by yourself, but go to the hospital for disinfection and medication change to avoid aggravation or spread of infection.
Can I drink alcohol after valve replacement surgery?
Whether alcohol consumption has good or bad effects on a heart patient cannot be absolutely determined. It is possible to drink alcohol in moderation, but patients with diabetes, high triglycerides, or poor heart function should avoid alcohol altogether, as it can aggravate existing conditions.
If these problems do not exist, you can still enjoy a small glass of wine before a meal or bed, but it is best to limit your alcohol consumption to one glass of wine or one glass of beer twice a day. In addition, alcohol still has harmful effects on the major organs of the body, and since alcohol increases the side effects of sleeping pills, do not mix sleeping pills, sedatives and alcohol if you are taking them.
When can I shower after flap replacement surgery?
If the wound has healed, you can start bathing, usually after 2 weeks after surgery, when the scabs on the chest incision have faded and the incision is free of redness, swelling and oozing, so you can take a shower. Do not immerse the wound directly in the bathtub or swimming pool until your doctor has given you permission. Do not use excessively hot water or bathe alone, and require family members to assist in wiping the body, and resume normal bathing after physical recovery.
Do not rub the wound hard, use neutral soap when cleaning the wound, move gently, avoid spraying directly on the wound with high speed water, and then gently dab the wound dry with a dry towel. This is also a better opportunity to check for changes in the wound and to contact the physician promptly if there is any redness, swelling, or oozing.
Patients with a flap replacement combined bypass may have a slow recovery of the leg wound, with crusts generally not receding until 3-4 weeks after surgery, or longer in some cases, and steps should be taken to protect the incision from drying and avoiding soaking when showering. If the incision is still oozing, red and swollen, or if the crust has not faded, please do not shower to avoid infection and contact the surgeon or follow up promptly.
Can I have an MRI or CT scan after flap replacement surgery because of other diseases? Will it cause any harm to my body? Will it affect the test results?
Many patients who are discharged from the hospital ask if they can have MRI or CT exams for other diseases. Do the valves, wires and temporary pacemaker leads in the body cause any harm to the body? Will it affect the test results? Please be assured that these tests can be done if needed, and the effects on the body (especially the MRI, which has some thermal effects) are small and generally do not cause substantial harm (it is recommended to communicate with the examining physician before the test, and if necessary, the parameters of the test equipment need to be adjusted before the test can be performed, as most hospitals do not have the ability to perform the test).
The quality of the imaging will be affected to some extent (especially the heart valve and sternal wire position), but the diagnostic results of the organs far from the heart valve and sternal wire position will generally not be affected.
Do I need to pay attention to my diet after valve replacement surgery?
Patients recovering from valve replacement surgery (usually within 1 month after surgery) usually need to increase their caloric, protein, and vitamin intake to promote a speedy recovery from surgery. Another aspect is to pay attention to the effect of diet on warfarin anticoagulation, for example, some foods rich in vitamin K may reduce the anticoagulant effect, such as animal liver.
The following is the amount of vitamin K (mg) per 100 g of dry food: spinach (4.40), cabbage (3.20), cauliflower (3.00), peas (2.80), carrots (0.80), tomatoes (0.40C0.80), potatoes (0.16), pork liver (0.80), eggs (0.80), and cow’s milk (trace). Of course, anticoagulation may be affected only when a large amount of a certain type of food is eaten. You may say there are so many foods with vitamin K content, do you need to write them all down? Actually, it is not necessary to remember all of them, but just to know some of them.
The patient must remember is that the following three conditions must be diligent anticoagulation check!
A, medication habits change: such as new drugs or the original drug dose adjustment (intravenous or oral drugs need to pay attention to).
B, a large change in dietary habits: for example, the patient moved from inland areas to coastal areas for a long time, the diet structure from beef and lamb-based to seafood-based.
C, sudden large changes in anticoagulation results in the original stable situation: for example, the original anticoagulation has been stable, suddenly once the anticoagulation results increased, INR more than 3.0, in order to prevent wrong results caused by test errors, it is recommended to immediately stop the same day and recheck the anticoagulation again.
When can I drink water normally after valve replacement surgery?
This question is often asked by patients, but it is also one of the most difficult questions for doctors to answer because there is no standard answer and it is influenced by too many factors. In general, the valve replacement surgery itself is definitely a blow to the heart in the early postoperative period and can affect the function of the heart. Therefore, we control fluid intake and water intake in the early postoperative period according to various in-hospital monitoring indicators, and even strictly control water intake when the patient feels very thirsty, in order to reduce the burden on the heart and facilitate early postoperative recovery.
But after discharge from the hospital, without all kinds of monitoring equipment and indicators, even if you go to ask the doctor, the doctor is unlikely to give you a standard answer. Here is a general principle for you: If the heart function is good before surgery, and the heart function is normal at the time of discharge review, then after discharge, you can drink water without too strict control, and you don’t need to restrict water to the point that you can hardly swallow even eating, and your tongue and lips are dry and cracked, as long as you feel slightly thirsty.
At the three-month review, if the heart function is normal, you can drink water normally, but do not drink a lot of water in a short period of time, just follow the principle of small amount and many times. However, if the heart function is significantly impaired before surgery or if heart failure has occurred, then the amount of water drunk after surgery needs to be strictly controlled, and the amount of water drunk should be increased slowly only after at least one month.
After being discharged from the hospital, it is important to maintain a somewhat thirsty state in the early stage and slowly increase the amount of water drunk gradually according to the situation. At the same time, you should closely observe whether you have symptoms of breath-holding, increased coughing, and coughing up thin white foamy sputum. If these phenomena occur, it is not just a matter of limiting water intake, but most likely you should strengthen the use of diuretics and go to the hospital for consultation.
There is another situation in which patients also often ask: “Doctor, I have good water control, I’m not stealing water at all, but I just have little urine, what should I do?” This condition is also related to many factors, such as the patient’s blood pressure, kidney function, heart function status, medications, etc. You can contact your supervising doctor, who may have a better understanding of your condition and can give appropriate solutions. It is more prudent to go to the hospital for further examination if possible.
Regarding drinking water, some patients and their families still do not have enough understanding. Some patients who went back to the doctor after being discharged from the hospital for heart failure told the doctor that they did not drink much water after being discharged from the hospital. Some of them are not idle and eat fruits, which makes doctors laugh and cry.
In some cases, the patient’s family did not allow him to drink in the ward, but he drank raw tap water in the bathroom when he went to the toilet. The purpose of these examples is to show that water control after heart surgery is one of the main elements of treatment and rehabilitation, and should never be ignored. If your mouth is comfortable, your heart may have to suffer, and in the end, it is you who suffers. As a family member, you should also join us and be a qualified supervisor.
In general, the following two principles need to be followed.
A, total control: the total daily water intake (including soup, fruit, thin rice and other water-containing foods) needs to be strictly controlled.
B. Time control: not to drink a lot of water for a short period of time (even if the total amount is well controlled, you should not concentrate on drinking too much water in a relatively short period of time).
Finally, a word of caution, after heart surgery, even if the review results of good heart function, but the heart can not be the same as normal people, in any case, do not drink a lot of water for a short time!
Can I have a normal sex life after valve replacement surgery?
The knowledge about sex has changed in the last few years and it is now considered that sex requires no more energy for heart disease than for other usual physical activities. If you can walk at a moderate speed and climb stairs easily, or climb 2-3 flights of stairs without any discomfort, you can resume sex, we recommend 1 month after heart surgery.
However, you must remember that it takes about 3 months for the sternum to heal and you should take care to protect it from compression during this process. You should pay attention to any pain, shortness of breath, fatigue or abnormal heartbeat, such as a change in heart rate outside the normal range, significant cardiac arrest or irregularity, etc. Once these symptoms appear, you should stop your activities and go to the hospital immediately. You should be aware of your recent blood pressure, and if it is unstable, it is recommended to hold off on sex. Also try to avoid having sex after a full meal or after drinking alcohol.
You should be aware that rheumatic heart disease does not affect your sexual organs and function in any way, therefore, heart disease and surgery itself do not lead to reduced sexual function in men or women. Patients with heart disease, however, often also have other types of vascular disease or take certain medications that can interfere with normal erections or cause impotence.
On the other hand, the psychological stress and worry associated with your heart disease and resulting surgery can cause sexual dysfunction. Neither you nor your sexual partner should feel pressured into this process and should allow yourself plenty of time to adjust step by step. As a rule, returning to a normal sex life requires a good mental state and a good physical state.
When should I go to work after surgery?
The return to work depends on how well you recover your energy and physical strength after surgery. Avoid participating in major decisions, such as stock speculation, financial management, work, family, marriage, etc., for at least one month after surgery. During the inpatient surgery, a lot of energy has been expended and after the surgery, it is normal for everyone to feel exhausted. With patience, your mental state and physical ability will gradually recover.
After 4-6 weeks of discharge from the hospital, you can discuss with your doctor the issue of returning to work. All these factors must be taken into account, as each person’s situation is different, as well as the duration, intensity and intensity of the work performed. Premature participation in physical work may affect the long-term prognosis. It is important that you give full consideration or consult your physician when you are ready to work.