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Post Surgical Care – Below the Knee

From the Colorado Dermatology Institute in Colorado Springs, Colorado.

Colorado Springs Dermatologist Dr. Reagan Anderson

Video Transcript

So here’s another daily do from your friendly local dermatologist!

All right, so we’re gonna talk today about probably one of the most difficult areas of the body to heal after a surgery and that’s below the knee, and the reason for this is that our circulation is not as good there because it’s further from the heart and so the further you are away from the heart, the less nutrients you get. The, the less blood return you get. Our legs swell at the end of every day and the wiser you get, older, the wiser you get, we all know that our legs swell more and more because the veins aren’t as healthy as they used to be. So think about it. You’re not getting as much circulation, every day you have swelling, swelling produces pressure, pressure tries to rip the wound open and it causes pain. So below the knee, that’s just a hard area to take care of. Now some studies say that infection rates below the knee can be as high as 30% I think that’s a stretch, but I definitely have noticed in my own clinical practice that if you’re going to get an infection somewhere 9 times out of 10 It’s below the knee. I think that’s for a couple of reasons, some of which we’ve already explained because you’re further from the heart you get less circulation, because there’s less circulation the wound takes longer to heal, because it takes longer to heal it takes longer to get watertight. So when you’re in the shower and the water is hitting your head and your neck and your armpits in your groin and it’s carrying all that bacteria down, if you let that water or moisture run over the wound before it’s had a chance to get watertight, that’s an infection. So I recommend below the need to not let it get wet for four days after the surgery, four days. Now sometimes I tell people that you can do the shower do the Captain Morgan right? You keep your leg outside of the water so it runs down. There’s also things that you can get that are made for casts, because if you have a cast for you know, two, three, four months, you have to shower some point. So they make kind of a plastic bag that you can put on you can get that at a drugstore and it’s, they’re cheap and so then you just put the plastic bag around and very little water will get through it or you can take a bath but keep the leg outside of the bathtub. There’s lots of things you can do, or sponge bath, but for four days, please don’t let the area get wet with water or sweat, so that it has a chance to heal without getting infected. Next thing I usually recommend is wear compression socks, all they are socks that come up to your knees. You can get them over the counter at your drugstore and you just put them on before you get out of bed in the morning and then you take them off before you go to sleep at night. So you don’t wear them when you’re sleeping. Now, if you have some sort of arterial or vascular compromise that’s going on in your legs, please talk to your doctor first to make sure the compression socks are okay, but if you can wear those compression socks the day of the surgery. So you put them on before you get out of bed. Then your legs aren’t going to be as swollen when you come in for surgery, therefore we’re not going to have as much effort or work that’s needed to pull the wound together, which means you get a better outcome and then you can put those compression socks on right when you leave the surgical room to keep the swelling from happening. If we can keep the swelling down it will help, now later on a lot of times the lower legs get tender or painful and that happens usually as the day progresses because more and more swelling is happening because we’re standing or sitting for longer and longer periods of time. More swelling equals more pressure, more pressure equals more pull, more pull equals more pain on the wound. So I usually recommend to ice the area for five minutes an hour, over the bandage, for the first day of the surgery. So after the surgery five minutes an hour for that day alone. I also recommend about once an hour laying on your back, putting your feet straight up against the wall, so your feet are up here your bottoms down here, and your torso is laying and you do that for five minutes an hour. What that’s gonna do is it’s gonna help drain that fluid back into your body. You drain the fluid there’s no swelling, less swelling less pressure ,less pressure less pull, less pull less pain. I think I got it right. The point is is that lower legs take extra effort. If you have something that makes you immunosuppressed like diabetes or you’re on cancer medications or anything like that, please talk to your dermatologist or provider doing the surgery before the surgery to see if maybe we should put you on a little bit of an antibiotic beforehand, because these areas have a higher incidence of getting infected. Guys, this topic is really important because between the knee and the ankle, It’s a hard area to heal. It’s a hard area to do surgery on. Please talk to your local provider. Please prepare, please wear those compression socks from the moment you wake up in the morning of the day you’re getting surgery, take them off in the clinic. All these things are going to help. Alright go get ’em!

Because Dermatologists treat more than just skin cancer!

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