Your child’s surgeon is:______________________________
Your child is scheduled for removal of stitches in the Operating Room on: ____________________at the ____________________facility.
Your child’s follow-up appointment is on __________ at ________________ in the Plastic Surgery Clinic at the _____________________ facility.
It is very important that you keep this appointment.
Please call the Children’s Mercy Hospital Plastic Surgery clinic at (816) 234-3020 or the Children’s Mercy South Clinic at (913) 696-8220 if you need to reschedule this appointment.
Appearance: The lip and nose area will be swollen with skin glue and clear stitches. The swelling should decrease within 3-5 days. Soft silastic nasal stents may be in place in your child’s nose if nose surgery was also done. These stents maintain the nose in the position it was corrected to. The nasal stents do not hurt your child.
Your child will have an IV in his hand or foot that will be removed after he is tolerating fluids by mouth. He will have his heart rate, respiratory rate, and oxygen saturation monitored for 12 hours after surgery. There will be wires taped to your child that go to the monitor to facilitate this. These should not stop you from holding or caring for your child. Elbow splints will be in place to keep your child from putting his hands to his mouth.
Pain control: Immediately after surgery your child will receive pain medication through the IV. When he is tolerating fluids by mouth he will be given pain medication by mouth. This medication can be alternated with regular acetaminophen (Tylenol®) as needed in the next few days. Ibuprofen (Motrin®) should not be used for 1 week as it makes the bleeding worse. You will be sent home with pain medication for your child.
The pain and irritability after cleft lip repair usually goes away within several days. Your child may seem more “clingy” than usual due to mild discomfort and a change in his routine. Excess crying puts tension on the suture line so it is a good idea to plan on giving your child extra holding and attention for several days.
Care of the incision: The incision will need to cleaned of any crusty drainage every 4 to 6 hours and after every feeding. A cotton swab dipped in solution of half water and half hydrogen peroxide works well for this. During incision care one or two stitches may come loose. Do not worry if that happens unless the incision opens up. The surgeon has placed a few extra stitches in case some come loose. Dermabond®, a skin glue is on the lip over the incision and stitches.
Care of the nasal stents: The nasal stents are stitched in place and help to maintain the nose correction. To keep them free of nasal drainage they should be irrigated with a few drops of saline solution and gently bulb suctioned every 4 to 6 hours. The stitch holding the stents in will be removed by the surgeon 1 week later. Do not worry if the stitch comes loose sooner. The stents will be worn for several more weeks, 12 hours per day for 12 weeks beyond that time. Nasal stents are an extremely important part of the therapy after nose surgery. They do not hurt, though some babies fuss when they are inserted because it makes the nose feel full. Your baby will quickly get used to you cleaning them and putting them back in place.
Feedings: The first feeding after surgery usually consists of a clear liquid such as Pedialyte®, glucose water or juice. This may be given when your baby is awake, alert and appears thirsty. Then breast milk or infant formula may be given with a soft rubber tip called a Brecht tip. After 24-48 hours you will be encouraged to resume breastfeeding or bottle- feeding. Pacifiers are not recommended for 1 week because they may cause the incision to break open. Spoons and straws should not be used for 3 weeks.
Positioning: Your child should be positioned on a firm surface, on his back, with the head of the bed elevated about 45 degrees. An infant car seat works well for this. Elevating the head helps to reduce swelling for the first 3 or 4 days. Do not place your baby on his stomach because the incision could break open if he rubs his face on the bed.
Elbow splints: Elbow splints allow your baby to move his arms about but do not allow him to bend his elbows. This prevents him from bringing his hands to his mouth and hurting the incision. They should be worn at all times unless you are holding him and keeping his hands from going to his mouth. The splints should be removed briefly, while you are holding him, about 6 times per day to exercise his arms.
Follow-up: The stitches will dissolve several weeks later. You will have an appointment in the Plastic Surgery Clinic in 1 week. The elbow splints should be worn until this appointment in the Plastic Surgery Clinic.
Call your child’s plastic surgeon or the plastic surgery post-op nurse at (816) 821-9474 (during the day Monday-Friday) or (816) 234-3000 (after hours or on the weekend) after your child is discharged if:
- your child runs a fever more than 100.4˚F (38˚C).
- your child is not drinking well or having at least 4 wet diapers in 24 hours.
- the incision becomes reddened, bleeds, or is oozing drainage after the first day home.
- your child does not calm with feeding or holding.
- you have questions about possible wound separation.
- you have questions or concerns.
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CMH-99-121
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Content Expires on 12/31/2011
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Children's Mercy Hospitals and Clinics
Kansas City,Missouri Overland Park,Kansas
Care cards are provided as a public education service. The information does not replace instructions your physician gives you. If you have questions about your child's care, please call your physician.
Estas instruccions son provistas como un servicio educacional. La information no sustituye las instrucciones de su medico. Si tiene preguntas encuanto al duidado de su niño, por favor llame a su medico.