Post Operative Management

Original Date: 02/2020 | Last Review Date: 03/2024
Purpose: To standardize postoperative management of various conditions.

Post-Operative Management Split Thickness Skin Grafts (STSG)

For skin grafts in which a negative pressure wound therapy dressing (NPWT; aka wound vac) is used:

  • Remove NPWT (wound vac) on POD 3.
    • Remove xeroform (or other non adhesive layer used, such as interface) to fully expose the skin graft.
  • Begin daily dressing changes:
    • Xeroform and polysporin dressing changes on skin graft
    • Moist kerlix on xeroform/polysporin
    • Dry kerlix on moist kerlix
    • Ace wrap (extremity) or other bandage (e.g. ABD pads for abdominal wound) to hold dressing in place

For skin grafts in which a gauze is left over the graft:

  • First dressing change is POD 2:
    • Remove all gauze except the xeroform (or other non adhesive layer used, such as interface) which is directly over the skin graft
    • Replace with moist kerlix on the xeroform (or other non adhesive layer used, such as interface)
    • Replace dry kelix on the moist kerlix
    • Ace wrap (extremity) or other bandage (e.g. ABD pads for abdominal wound) to hold dressing in place
  • Second dressing change is POD 3:
    • Remove all gauze and the xeroform (or other non adhesive layer used, such as interface) to completely expose the skin graft.
    • Apply xeroform and polysporin to the skin graft.
    • Moist kerlix on xeroform/polysporin layer.
    • Dry kerlix on moist kerlix
    • Ace wrap (extremity) or other bandage (e.g. ABD pads for abdominal wound) to hold dressing in place
  • Daily dressing changes thereafter:
    • Remove xeroform and polysporin from the skin graft.
    • Apply xeroform and polysporin to the skin graft.
    • Moist kerlix on xeroform/polysporin layer.
    • Dry kerlix on moist kerlix
    • Ace wrap (extremity) or other bandage (e.g. ABD pads for abdominal wound) to hold dressing in place

Peripancreatic Drain Management

Consider drain removal once patient is tolerating an oral diet or goal gastric tube feeds.

  • Once output is less than 50 cc/day, check a serum and drain amylase.
  • Drain amylase less than three times the serum amylase: remove drain
  • Drain amylase greater than three times the serum amylase: continue drain until
    • Output <10 cc/day, or
    • Drain amylase level falls below three times the serum amylase on repeat