Post-Operative Prescription

Syndactyly Release - Post-Op Dressing Visit

Rx

• 1 tablet TDS (three times daily) after food
• Duration: 5 days
• If any GI sensitivity, switch to Tab. Paracetamol 500 mg TDS alone

• 1 tablet BD (twice daily) after food
• Duration: 5-7 days
• Covers skin flora, gram-positive organisms, and wound contamination prophylaxis post-dressing

• 1 tablet OD (once daily), before breakfast
• Duration: 5 days
• Co-prescribed to protect gastric mucosa from NSAIDs

• Apply a thin layer directly over the wound/graft site at each dressing change
• Use sterile technique

• Apply over the wound surface to prevent dressing from sticking to graft or wound bed
• Cover with dry sterile gauze
• Secure with crepe bandage / non-stretch adhesive dressing

• Dorsal slab / volar plaster splint to be maintained:
  • Wrist in ~30° extension
  • MCP joints in ~60-70° flexion
  • IP joints in full extension
  • Thumb in palmar abduction-opposition
• Hand to be kept elevated above heart level at all times (sling when ambulatory)

• 1 tablet each OD
• Duration: 2 weeks
• Promotes collagen synthesis and wound healing

Dressing Change Instructions

• First dressing change: 24-48 hours after the previous dressing (or as directed by surgeon)
• Subsequent changes: every 1-2 days, or when soiled/wet
• Observe strict sterile technique at every dressing change
• Moist dressings (saline-soaked gauze) may be used if wound has dry eschar or adherent debris
• Watch for: increasing redness, swelling, purulent discharge, fever - report immediately
• Whirlpool/warm saline soaks can assist in gentle dressing removal if dressing is stuck

Instructions to Patient

• Do NOT get the dressing wet; keep hand dry
• Keep hand elevated as much as possible to reduce swelling
• Begin gentle active finger movements of non-operated digits immediately
• Do NOT remove splint without doctor's instruction
• Return immediately if: fever >38°C, severe pain, foul smell from wound, or numbness/bluish discoloration of fingers
• Follow-up: After 5-7 days for wound inspection and further management; suture/dressing review at 2 weeks

Next Follow-up

Clinical note: Syndactyly release often involves skin grafting (full-thickness or split-thickness) of the web space. Graft take is a priority in early post-op care - avoid shear, keep moist (but not macerated), and maintain immobilization in splint. Active digit motion should begin early once the graft is secure.

References: Campbell's Operative Orthopaedics 15th Ed 2026; Sabiston Textbook of Surgery

Zincovit Tablet

• Zinc sulphate 27.45 mg (elemental Zinc 10 mg)
• Vitamin C 150 mg
• Vitamin A, B-complex (B1, B2, B3, B5, B6, B12), Vitamin D3, E
• Folic acid, Biotin, Selenium, Manganese, Copper

Why Zincovit is Better Here

Corrected Line in Prescription

Tab. Zincovit - 1 tab OD after food x 2-4 weeks

Plastic Surgeon's Post-Op Prescription

Syndactyly Release - Dressing Visit (20F)

Rx

A. SYSTEMIC MEDICATIONS

• 1 tab BD after food × 7 days

• 1 tab TDS after food × 3 days
• Then step down to Tab. Ibuprofen + Paracetamol (400+325 mg) TDS × 3 days

• 1 tab OD before breakfast × 7 days

• 1 tab OD after food × 4 weeks

• 1 tab OD × 4 weeks
• Antioxidant support for graft take and tissue healing

• 1 tab TDS on empty stomach × 5-7 days
• Reduces post-surgical edema, inflammation, wound debris - very commonly prescribed by plastic surgeons

B. TOPICAL / LOCAL MEDICATIONS

• Apply thin layer over raw wound/suture line at each dressing change
• Use with sterile gloves

• Non-adherent antibiotic-impregnated dressing
• Place directly over graft/wound bed
• Preferred by plastic surgeons over plain paraffin gauze - provides local antibacterial cover and prevents graft desiccation

• For gentle soaking/removal of adherent dressings
• Prevents graft disruption during dressing change

C. SCAR MANAGEMENT (started after wound fully closed ~3-4 weeks post-op)

• Apply twice daily over healed wound/scar
• Continue for 3-6 months
• Gold standard for hypertrophic scar and web-space contracture prevention after syndactyly release

• Apply OD-BD over scar × 3 months
• Alternative/adjunct to silicone if cost is a concern

• Apply over scar when exposed to sunlight
• Prevents post-inflammatory hyperpigmentation of graft/scar - very relevant in Indian skin tones

D. PHYSICAL / REHABILITATION ORDERS

(Written as instructions on prescription pad)

• Compression therapy: Custom-made compression glove / elasticated bandage over web space once wound healed - wear 23 hrs/day × 6 months
• Splinting: Static night splint maintaining web space in extension × 6 months post-op (prevents contracture recurrence)
• Hand physiotherapy: Begin active finger range-of-motion exercises once graft take confirmed (~2-3 weeks)
• Occupational therapy referral: For ADL training and customized splint fabrication

E. WOUND DRESSING PROTOCOL (Written Explicitly by Plastic Surgeons)

F. FOLLOW-UP PLAN

Key Plastic Surgery-Specific Additions vs. General Rx

Bottom line: The plastic surgeon's prescription goes well beyond the wound itself - it actively manages graft take, scar quality, and long-term contracture prevention, which are the real determinants of surgical success in syndactyly release.

OPD Dressing Requisition Note

(To be given to nurse / ward staff)

Please Arrange the Following for Dressing:

STERILE FIELD SETUP

CLEANING AGENTS

DRESSING MATERIALS

TOPICAL MEDICATIONS

INSTRUMENTS

SPLINT / SUPPORT

EXTRAS / SAFETY

Procedure to be Done:

• Dressing change only
• Suture removal
• Splint change/renewal
• Wound inspection + photograph

Nurse's note: Please set up dressing trolley 10 minutes before patient is called in. Keep hand elevated on pillow. Soak outer bandage with NS before removal if adherent. Do NOT pull dressing off dry.

What Patient Must Buy from Pharmacy

Please purchase and bring to OPD:

Full Dressing Procedure - Post-op Syndactyly Release

Step 1 - Position the Patient

• Patient seated comfortably
• Hand rested on sterile drape on dressing table
• Hand at table level, well lit

Step 2 - Remove Old Dressing

• Loosen micropore/tape at edges first
• Remove crepe bandage layer by layer
• If gauze is adherent to wound - soak with Normal Saline for 2-3 minutes, then gently lift
• Never pull dry - this disrupts graft and suture line
• Remove Sofratulle last, very gently

Step 3 - Wound Inspection

• Color of graft/wound - pink = good, pale/dark = concern
• Graft adherence - is it stuck down or floating/boggy?
• Suture line - intact, any dehiscence?
• Discharge - serous (normal), purulent (infection), hematoma (dark collection)
• Surrounding skin - redness, swelling, warmth
• Finger tips - color, capillary refill, sensation (check circulation)

Step 4 - Cleaning the Wound

• Take Normal Saline in sterile bowl
• Using sterile gauze + forceps, gently clean wound from center outward
• If slough present - clean with dilute Betadine (1:10 in NS), then rinse with NS
• Pat dry with sterile gauze - do NOT rub
• Do NOT use hydrogen peroxide directly on graft - it is cytotoxic

Step 5 - Apply Topical Medication

• Apply thin layer of Mupirocin (T-Bact) over suture line and wound edges using sterile gauze or gloved finger
• Avoid piling thick ointment - thin coat is enough

Step 6 - Apply Non-Adherent Layer

• Cut Sofratulle to size of wound
• Place gently over wound/graft - smooth, no folds
• This layer must not be tight - just resting over the wound
• This prevents next gauze layer from sticking to wound

Step 7 - Apply Absorbent Gauze Layer

• Place 3-4 sterile gauze pieces over Sofratulle
• Build a slightly bulky layer - absorbs any ooze, protects wound
• Ensure web spaces between fingers are packed lightly with small gauze pieces to prevent skin-to-skin contact and maceration

Step 8 - Wrap with Crepe Bandage

• Start from finger tips going proximally (distal to proximal)
• Wrap in figure-of-8 pattern around fingers/web space
• Firm but NOT tight - you must be able to slip one finger under the bandage
• Check fingertip color after wrapping - should remain pink
• Secure end with micropore tape

Step 9 - Reapply Splint (if needed)

• If plaster slab is intact and well-fitting - reapply over dressing
• Maintain position:
  • Wrist 30° extension
  • MCP joints 60-70° flexion
  • IP joints full extension
  • Thumb in abduction
• Secure with crepe bandage over slab

Step 10 - Final Check

• Check all fingertips - pink, warm, capillary refill < 2 seconds
• No numbness reported by patient
• Dressing not too tight
• Give arm sling before patient stands up
• Instruct to keep hand elevated

Tell the Patient Before She Leaves:

• Keep hand raised above heart level always
• Do NOT wet the dressing
• Come back in 2-3 days for next dressing
• Return immediately if: fingers turn blue/white, severe pain, foul smell, fever

Total dressing time: approximately 15-20 minutes for post-op syndactyly release with graft site.

Sofratulle vs Cuticell - Quick Difference

Which to Use Here?

• Cuticell Classic - ideal choice
  • Non-adherent, paraffin-based
  • Protects graft
  • Does NOT disturb wound bed on removal
  • Clean wound = no antibiotic tulle needed
  • Mupirocin (T-Bact) on suture line separately is enough antibiotic cover
• Use Sofratulle only if wound shows signs of infection or contamination

Corrected Pharmacy List - Item 1

Cuticell Classic (paraffin tulle, non-adherent dressing) - 1 pack