This page explains about looking after your child after hand or foot surgery and what to expect when your child comes to Great Ormond Street Hospital (GOSH).
If your child has had hand or foot surgery, you will need to take care of your child’s bandage, know what things to avoid and make follow-up arrangements.
Prevention of swelling
For the first few days after surgery, preferably until the operation site has healed, your child should keep his or her hand or foot raised to prevent and reduce swelling.
You can use pillows and cushions to support and raise your child’s hand or foot. If your child has been given a sling to use, you should take this off at night.
Pain relief
Your child will need regular pain relief for a few days after the operation. After some operations, you may need to give regular pain relief for longer. The ward staff will explain how much pain relief medicine to give and how often before your child goes home.
Keeping the hand or foot raised will also make it more comfortable.
Keep the bandage dry
This is essential for good healing. Children who have a dressing changed under general anaesthetic planned should not have a bath until this has been done.
A strip wash is preferable to your child having a bath. If a bath is really necessary, either have an extra person with you to hold your child’s hand or foot out of the water or otherwise cover the bandage with a plastic bag. This will only protect against splashes of water, so if your child puts his or her hand or foot into the water, even for a second, water will seep into the bag making the bandage wet.
If the bandage becomes wet, please ring the clinical nurse specialists or ward staff to arrange for the bandage to be changed. Please do not try to dry the bandage with a hair dryer as the top layers can seem dry but the underneath ones will stay wet. Wet bandages can lead to infection, loss of skin graft or breakdown of the operation site.
Avoid messy play
Your child should avoid playing with clay, water, sand or play dough as these can cause irritation if they get under the bandage. Irritation of the operation site can slow down healing or cause an infection.
It is also advisable to avoid painting, both because it could irritate the operation site and also because it can be difficult to tell the difference between red paint and blood.
General hints
We advise putting a large sock over the bandage to keep it clean for normal day-to-day activities.
Your child will find it easier to get dressed with the bandage in place if you provide extra large or baggy clothing.
Loosening of the bandage
If your child’s bandage becomes loose or starts to slip, please make it as secure as possible applying extra tape if needed, and ring the clinical nurse specialists or ward staff to arrange for the bandage to be changed.
If the bandage falls off, cover your child’s hand or foot with clean, non-fluffy, cotton material and ring the clinical nurse specialists or ward staff to arrange for the bandage to be changed.
Illness
If your child becomes unwell, it may be connected with the operation but it may be any other childhood illness.
Do not remove the bandage but check the following:
- Does your child have a temperature higher than 37.5°C?
- Can you see any swelling or redness near the bandage?
- Does there seem to be any staining on the bandage that has come from the inside?
- Is your child complaining of tingling under the bandage?
- Does your child’s hand or foot smell unpleasant?
If you have answered yes to any of these questions, please ring the clinical nurse specialists or ward staff for advice. They may advise you to go to your family doctor (GP) or come to the ward for review.
If your child’s bandage smells but they remain well and there is no increase in pain, this is not necessarily a reason to worry. Contact the clinical nurse specialists or ward staff, who might suggest changing the dressing earlier than planned.
Dressing changes
If your child has had a skin graft, he or she is likely to need at least one dressing change under general anaesthetic. This is because initial the graft may be fragile and the first dressing painful. This dressing change is usually done on a day case basis, where your child comes into hospital and returns home the same day.
If your child has had a k-wire inserted, it will be removed at the appropriate time, either under general anaesthetic or in the dressings clinic.
The clinical nurse specialists will carry out further dressing changes in an outpatient appointment, usually on Wednesday mornings on Dinosaur Ward. We will give you an appointment before your child is discharged home.
While your child’s dressing is being changed, the clinical nurse specialist will liase with the occupational therapist regarding pressure garments or splints if required. You may need to see the occupational therapist during this appointment or make a separate one.
The team will review your child about three months after the operation during an outpatient appointment. This will give them the opportunity to assess your child’s progress and play any further treatments that may be needed. If your child does not need any further operations, the consultant will see your child at an outpatient appointment about one year later.
Last reviewed by Great Ormond Street Hospital: September 2012
Ref: 2012F0116 September 2012
Compiled by the Department of Plastic Surgery in collaboration with the Child and Family Information Group.
This information does not constitute health or medical advice and will not necessarily reflect treatment at other hospitals. If you have any questions, please ask your doctor. No liability can be taken as a result of using this information.
