What do you need to bear in mind if you have external ear reconstruction surgery?

The advice below will help patients who have had external ear reconstruction surgery to recover:

• We recommend you sleep with your head raised, without lying on the operated area.
• We advise you treat the wound with an antiseptic solution and keep it clean and dry.
• Avoid getting the area wet during your daily hygiene routine until medical personnel advise otherwise.
• Keep the area covered to avoid blows.
• It is very important that after the surgery you begin to move as soon as possible and gradually (avoiding pressure or shock to the operated area).
• It is a good idea to start breathing exercises as soon as possible using the tips provided by the hospital.
• Avoid prolonged exposure to sunlight.
• If you notice any signs of infection (swelling, fever, redness, localised heat or pus-like secretion), bleeding, tissue damage, new or increased pain, you must go to A&E.
• Follow a balanced diet, increasing intake of proteins where possible to encourage tissue regeneration.
• The treatment you should follow will be given in your medical discharge report: it generally includes pain relief (to reduce pain) and antibiotics (to avoid infections).
• You can continue living as you normally would after the operation, but during the first few months you should avoid exercise and overexertion, such as lifting heavy weights.
• It is advised to completely abstain from the consumption of tobacco and other toxins, as they slow the healing process.

Other related health information

• Breathing exercises
• Nutritional Service
• Preventive Medicine Service

Recommendations

• Gentle aerobic exercise 3-4 days a week.
• Gentle muscle-toning exercises 2-3 times a week.
• Exercising in water.
• Balanced diet adapted to other possible comorbidities.
• Balancing exercises which may include Tai Chi to prevent falls.

Basic recommendations

In the kitchen

• Frying pans: hot oil or flame caused by oil
• Pressure pots and pans: hot liquids
• Glasses, mugs and plates: due to spillage of liquids
• Microwaves: due to liquids or depilatory wax
• Oven door: by contact, especially in children

In the bathroom

• Unblockers - Sulphuric acid
• And caustic soda mixed or combined with bleach are highly dangerous, whether due to inhalation of the mixture or due to contact on explosion.
• Hot tap water: regulate boilers to prevent the water from causing burns. 

Rest of the house

• Electricity, plug sockets, electrical extension lead, clothes iron by contact or steam.

Other most common injuries

• Motorbike exhaust pipe
• Special attention when handling firecrackers and sparklers, (especially in children)
• Burning alcohol or gasoline in barbecues.
• Colognes or sprays near sources of heat (candles) 

What to do when you burn yourself, using some of the methods below:

• It is very important to move away from the source of the burn: flame, hot water, electricity, hot solid, steam, etc.
• Cool the affected area, thus halting the spread of the heat in the skin and body tissue, preventing the injury from getting any worse. This also works in acid burns as you will dilute the product and its impregnation into body tissue. Use cold water for 10 or 15 minutes depending on the agent that caused the injury.
• Once the area is cool, there may be some redness to the skin, with more or less pain or discomfort (hot water, superficial flame, sun burn).
• It can be soothed with water or cold cloths, and by applying moisturisers.
• If blisters appear, there is loss of skin, or white or pearly blotches after cooling, you must keep the affected area covered with gauze, a towel, a sheet, etc.
• If there is pain, cold water can be applied to this cover.
• If the burn is on the face, neck, hands, major joints, groin or perineum (the area between the genitals and the anus), it should be assessed by a specialist.
• Special care should be taken with children and the elderly as they may require special attention to their injuries.

If the injuries only cover a small area, you should first go to a health centre. For more widespread injuries, go to the hospital accident and emergency department or 112 emergency services.

What do you need to bear in mind if you have resistant osteoarticular infections?

When the patient is discharged, nursing staff will give them all the support and information they need to be able to look after the wound themselves. Most patients will be fitted with an external fixator that needs daily care, so healthcare staff will emphasise the importance of hygiene in the affected area, which should be cleaned daily and the correct dressing applied.

If patients are not independent and do not have a relative or carer to look after them, the local health authority will be contacted (through the PREALT discharge preparation unit), so that they may be provided with nursing care. If patients are being treated with intravenous medication, the Hospital at Home Unit will be contacted to follow up and provide the relevant treatment.

It is also necessary to explain the importance of taking the medication prescribed. On being discharged, most patients will receive long-term oral antibiotics (prescribed by the Infectious Diseases Unit) and they are reminded of the importance of maintaining a fixed schedule and not forgetting to take their medication.

They are also reminded of the need to maintain healthy habits, such as:

• Being well hydrated
• Eating properly (protein-based diet)
• Stopping toxic habits (should they have any), such as alcohol and tobacco

What do you need to bear in mind if you have sarcoma or other musculoskeletal tumours or you are caring for someone who does?

It is important to follow a series of advice related to lifestyle and treatment. The most important advice is:

• Diet and hydration: follow a healthy and balanced diet, ensuring it includes the necessary foods, proteins and calories.
• Control over passing urine and faeces: there is a tendency to constipation caused by pain medication (morphine or derivatives), which is why a diet rich in fibre is recommended.
• Unhealthy habits: avoid habits such as smoking, drinking or taking other toxins.
• Hydration and skin awareness: the skin normally becomes very delicate and deteriorates due to the effects of aggressive treatment.
• Control of post-surgical wounds: wash using less aggressive soaps and keep your skin well hydrated.
• Side effects (localised and systemic) of medication: watch for and avoid effects such as nausea, vomiting, diarrhoea, skin peeling, itchy skin, etc.).
• Education and keeping extremities mobile: sometimes there are cases of amputation and phantom limb syndrome.
• Maximum empowerment of the patient’s independence in the new situation and provide the necessary tools: crutches, walkers, wheelchairs, etc.
• Pain management: medication, relaxation techniques, breathing control, mobility techniques and energy saving.
• Education in injury and fall prevention: wearing appropriate footwear, adapting the home (removing barriers), walking safely, wearing comfortable clothing, etc.
• Infection control: keep an eye on temperature and symptoms. It is worth remembering that this is an immunosuppressant condition.
• Insistence on the importance of oral hygiene.
• Information and assessment of correctly taking medication.
• Vigilance and control of port-a-cath, if the patient has one.
• Sleeping at night and resting during the day to enable proper rest at night time.
• More direct professional support for the patient, their family or carer: necessary, adequate and understandable information should be provided about the illness and treatment. Support must be provided in paper format and other types of professionals can also give their support.
• Respect the patient’s independence and the decisions they make.
• Information about patient’s wishes.

What do you need to bear in mind if you have diabetic foot?

The complications of diabetes mellitus with high blood sugar and/or poor metabolic control may end up causing injuries to small vessels, such as diabetic retinopathy and diabetic nephropathy, or large vessels, such as diabetic arteriopathy.

This affectation also extends to protective sensitivity to injuries, and causes signs of peripheral nerve damage. It may present as sensory, motor or autonomic nerve damage.

The most frequent form is sensory/motor and one of the serious complications is Charcot foot and ankle. The combination of nerve and artery damage with foot infection may be considered a serious complication.

Symptoms

Although it may start more severely, the main symptoms of diabetes are:

• Being very thirsty
• Being very hungry
• Needing to urinate a lot

And the symptoms that may indicate the beginning of diabetic foot are:

• Loss of feeling in the feet
• Pain at night
• Intolerance to bed sheet friction
• Dry skin that may lead to cracking
• Changes in the points of support on the feet
• Appearance of hard skin and ulcers that may lead to amputation

Epidemiological data

Around 15% of patients diagnosed with diabetes get diabetic foot. Between 40% and 50% of diabetics will have an ulcer and 20% will need an amputation. More than 50% of non-traumatic leg amputations are performed in diabetics.

Diagnosis

Clinical, analytical and screen for early detection.

Treatment

Depending on symptoms and preventive.

Prevention

Prevention of diabetic foot includes good metabolic control alongside a healthy lifestyle and professional foot care

What do you need to bear in mind if you need periacetabular osteotomy surgery?

In the months running up to the operation patients are advised to follow an iron-rich diet. In addition, three doses of intravenous iron will be administered and, in some cases, a dose of erythropoietin glycoprotein to stimulate the production of red blood cells.

So that patients are able to be independent, they will be taught to walk with no pressure (without putting weight on the operated leg) and with partial pressure (only putting weight on the tips of their toes) using crutches so that they can walk on their own.

After the operation, patients will have their blood pressure, heart rate and temperature monitored, and they will have a finger prick done to check for anaemia.

Where possible, younger patients will not be given blood transfusions. By correctly tolerating low haemoglobin levels, this patient group is able to more easily trigger the body’s physiological mechanisms without complications to try to compensate for the blood lost during surgery. For this reason it is very important to rigorously monitor vital signs.

Once in the hospital, the person and their family should be informed about the exercises to be performed:

• Maintenance of the anti-rotation leg box, if required.
• Internal rotation exercises.
• Attempt to sit up on their own 24 hours after surgery.
• Doing mobility exercises with a pillow between their legs for the patient’s comfort.
• Training for the person’s family on how to carry out pumps, flexoextension, passive abduction and triple extension exercises so that they can help the patient.

Nursing staff and physiotherapists can teach the patient how to carry out deep breathing exercises, which:

• Prevent blood pressure from dropping, and help to oxygenate because rest reduces oxygenation of tissues
• Supply a large amount of oxygen to the lungs
• Ventilate and clean the lungs
• Activate the body’s relaxation response
• Stimulate the heart
• Promote bowel movements
• Massage the organs

Patients will move about and walk in the following three stages, depending on x-ray exams:

• First four weeks: leaning on the tips of the toes so as not to lose balance
• Partial pressure: from four weeks on
• Total pressure: from six weeks on

Pain will be controlled using intravenous drugs for the first few days and, after that, oral medication. In order to alleviate pain, a cold compress will need to be applied on the area for twenty minutes three times a day.

To prevent thromboembolism, patients will be treated with subcutaneous heparin injections. The hospital admissions unit’s nursing staff will show them how to administer this.

Remember

• Exercises must always be assisted (by a family member).
• The patient will walk or move from their chair to the bed without putting their weight on the operated leg.
• If the articular capsule has been operated on, the leg should not be rotated towards the exterior.