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This website is under development - The information contained on this site is for guidance only and is not intended for self diagnosis or self treatment. This will not replace professional medical advice or consultation. Always seek the professional advice of a qualified health care professional.   
Pre Op Check list - patient    Prevention & Treatment
Prevention is better than cure. During your stay in the hospital, we will take all reasonable steps to minimise the risks. Some of the steps we take to achieve this are detailed below. If a side effect or complication should occur (for example wound infection), then you should promptly report to the hospital/GP as starting appropriate treatment early is likely to resolve the problem.

DVT/PE (Blood Clot formation) : We will provide you with elastic stockings (TEDs) which compress the veins in the calf and keeps the blood flowing in the deeper veins. In patients with high risk of DVT formation, during surgery, we tend to use special foot or calf compression mechanical pumps to keep the blood flowing. In addition to this, as the operation is done in the upper limb, we will encourage you to mobilise early and ensure that you are well hydrated. In patients we will use blood thinning injections especially when use of TEDs stocking is contra-indicated.

Infection: We screen for any presence of organism like MRSA in all patients and deal with these before the operation. All the shoulder operations are done in ultra-clean air theatre where the air is micro-filtered and cycled at the rate of about 100 cycles per minute. I generally use alcoholic chlorhexidine gluconate as a cleaning agent to the skin. This has been shown to have long residual action to keep the skin sterile during operation. When implant surgery is done, then I will also use a broad spectrum antibiotics to keep the infection risk minimal. When doing joint replacement surgery, my team will use a hood/mask system as well.

Bleeding: I use electric cautery to stop bleeding from the small blood vessels. When performing open surgery, and if needed larger blood vessels are tied down to stop bleeding. In addition pressure dressing is applied to minimise this risk.
Nerve damage: Damage to nerves in the skin are inevitable. They will result in loss of sensation around the scar. However, these are minor side effects from surgery and will not lead to serious problems in future. Numbness will diminish with time. Damage to the deeper nerves are rare. I take extreme care to keep this risk low. In the 7,000 + operations I have done (including those for trauma) I have had 3 cases where the deeper nerves failed to function normally quite possibly due to bleeding and pressure. In these 2 cases, the damaged nerves recovered fully over a period of time. When it does occur it is quite disabling but with physiotherapy and splints, the arm is kept in a functional position during recovery. Damage to individual branches of nerves are not uncommon and occur in the rate of 1:500 and more often than not recover over a period of months. Radial nerve may take on an average 18 months to recover.

Stitch abscess: Many of the sutures used during surgery will dissolve over a period of time. The ‘dissolving’ of the suture is because your body will slowly ‘digest’ the suture material. This tends to happen between 4-6 weeks after the surgery. Sometimes your body can throw an intense reaction during this time which can result in a small abscess. Very infrequently, small purple colour suture material may come out. All it requires in this situation is a good clean up, removal of any suture material which has not digested and if necessary a course of oral antibiotics.

Complex Regional Pain Syndrome: This is a rare complication that occurs in the frequency of 1 in 500 or less. There is no easy way of predicting who will get this. This occurs due to sensitised nerves. It is more common in people who have had it before. It can be minimised by taking high dose vitamin C, judicious use of strong painkillers, use of special nerve agents like pregablin/gabapentine and more importantly, prompt participation in the rehabilitation.