Wound care and managing your drains

• Remove any bandages and shower normally the SECOND DAY AFTER SURGERY (unless otherwise instructed by your surgeon).
• Do NOT soak or immerse your incision in water for 1 month. (No tub baths, swimming pools or jacuzzi.)
• Gently wash over your incision(s) DAILY with soap and water. Pat dry and leave open to air. Do NOT put any lotion or ointments on the incision. Do not scratch the incision.
• You can shower with your drains. You may put a long string, lanyard or ID holder around your neck to pin the drains to (so you do not have to carry the drains while you're in the shower).

• You may wear a SOFT bra (NO UNDERWIRE) for support for 2 weeks. No dressings are required unless there's drainage. Please do NOT put any hot packs or ice packs on your incisions due to the risk of wound blisters.
• You can pin your drains to your clothes so they do not tug or pull.

You may apply Bacitracin ointment (over-the-counter topical medication) to your sutures 2x/day for one week. If you have steri-strips or paper tape on your sutures, please do NOT apply Bacitracin on it. (The steri-strips will fall off on their own.)

Your sutures are dissolvable—unless you have blue sutures, in which case you will come back to the plastic surgery clinic to have them removed.

At your follow-up visit, the nurse practitioner or physician assistant will check your wound and remove any sutures, staples, or steri-strips.

A Jackson-Pratt (JP) drain is the most common type of surgical drain. It carries the fluid into a collection bulb that you empty.

The drain uses suction created by the bulb to pull the fluid from your body into the bulb. The rubber tube will probably be held in place by one or two stitches in your skin. The bulb will probably be attached with a safety pin to your clothes or near the bandage so that it doesn't flip around or pull on the stitches.

A Penrose drain is a different type of drain that does not have a bulb.

Instead, the end of the tube is open. That allows the fluid to drain onto a dressing taped to your skin. The drain may be kept in place next to your skin with a stitch or a safety pin in the tube.

When you first get the drain, the fluid will be bloody. It will change color from “kool-aid” red to pink to a light yellow or clear as the wound heals and the fluid starts to go away.

Your doctor may give you information on when you no longer need the drain and when it will be removed.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

• Strip the drains using an alcohol swab and empty three times daily (or whenever the drain appears full). Record output for each drain and bring your drain log to your follow-up appointment.
• Keep drain to “bulb suction.”
• Keep drain pinned to clothing to prevent pulling and discomfort.

If you have multiple JP drains, calculate EACH drain's 24-hour total SEPARATELY.

• If each drain has a 24-hour total less than 30 ml for AT LEAST 2 CONSECUTIVE DAYS, please call the plastic surgeon's office for possible drain removal (in the office).

Note: Not all of the drains may be removed at the same time.

Follow any instructions your doctor gives you. How often you empty the bulb depends on how much fluid is draining. Empty the bulb when it is half full.

1. Wash your hands with soap and water.
2. Take the plug out of the bulb.
3. Empty the bulb. If your doctor asks you to measure the fluid, empty the fluid into a measuring cup, and write down the color and how much you collected. Your doctor will want to know this information.
4. Clean the plug with alcohol.
5. Squeeze the bulb until it is flat. This removes all the air from the bulb. You may need to put the bulb on a table or a counter to flatten it.
6. Keep the bulb flat, and put the plug in. The bulb should stay flat after you put the plug back in. This creates the suction that pulls the fluid into the bulb.
7. Empty the fluid into the toilet.
8. Wash your hands.

You may have a dressing (bandage). The dressing is often made of gauze pads held on with tape. Your doctor will tell you how often to change it.

1. Wash your hands with soap and water.
2. Take off the dressing from around the drain.
3. Clean the drain site and the skin around it with soap and water. Use gauze or a cotton swab.
4. When the site is dry, put on a new dressing. The way your dressing is put on depends on what kind of drain you have. You will get instructions for your type of drain.
5. Wash your hands again with soap and water. Your doctor may ask you to keep track of your dressing changes. Write down the time of day and the amount and color of the fluid on the dressing.

Squeezing or “milking” the tube of your surgical drain can help prevent clogs so that it drains correctly. Your doctor will tell you when you need to do this.

In general, you do this when:

• You see a clot in the tube that prevents fluid from draining. The clot may look like a dark, stringy lining.
• You see fluid leaking around the tube where it goes into the skin.

How to squeeze (“milk”) the tube:

• Use one hand to hold and pinch the tube where it leaves the skin.
• With the thumb and first finger of your other hand, pinch the tube just below where you’re holding it.
• Slowly and firmly push your thumb and first finger down the tubing toward the end of the tube.
• Repeat this as many times as needed to move the clot. If you have a Jackson-Pratt (JP) drain, the clot should move down the tube and into the bulb. If you have a Penrose drain, the clot should move into the dressing.