Minor Operations

INTRODUCTION

My minor operating theatre lists for private patients are held in the Out-Patient Department of the Shelburne Hospital on Wednesdays, Saturdays and Thursdays at The Chiltern Hospital. I have particular expertise in dermatological surgery. To book an appointment, please contact my Secretary on 01494 866600.  The final decision as to the most appropriate type and place for surgery will be made at the time of consultation. If you have a holiday or other important commitments please check with Dr Ali whether you should postpone surgery until your return.

You may eat and drink normally prior to your visit.  We advise you not to fly post-surgery.  A minor operation takes between fifteen to sixty minutes and you should normally be able to go home directly after the procedure has been completed.  If you feel at all nervous, it is a good idea to bring a friend or relative for moral support.  All young people under the age of 16 must be accompanied by a parent or guardian.  Our expert nursing team will be able to offer advice and information pre and post operatively.

SUMMARY OF MINOR OPERATION PROCEDURE

Types of procedures carried out at the minor operations clinic

Excision:  This means the complete removal of a lump, mole or blemish.  The skin will be repaired to leave as neat a scar as possible.  The piece of skin removed will normally be sent to a laboratory for confirmation of the diagnosis.

Biopsy with histology:  This means taking a small sample of skin to send to the laboratory for testing.  This test will help to make an accurate diagnosis of your problem.  A biopsy is frequently performed on rashes or on large lesions that are too big to remove completely.  The skin wound will be very small, usually about one centimetre long, but will need closing with sutures.

Minor procedures:  These include simple techniques such as curettage (scraping off), shave excision (shaving off), cautery (burning), cryotherapy (freezing) or electrodiathermy (coagulation).  These procedures usually result in small superficial wounds similar to grazes or light burns.  They do not require stitches, but may need (daily) cleaning with dilute antiseptic and covering with a non-occlusive plaster for a few days until they dry up and heal.  This can be done by yourself at home and my nursing staff will give you detailed information.

CLINIC ROUTINES

Consent Form

You will be asked to sign a consent form (unless you are under 16 when a parent or guardian must sign).  This form indicates to us that you are aware of the procedure that we are going to carry out.  Most minor operations need local anaesthetic (pain killer) to numb the area.  This will be injected just under the area to be treated.  General anaesthetic, the type that puts you to sleep, is never used in Out-patients.

When you are asked to sign this form, please tell us about any/all pills, tablets, medicines or sprays that you are taking, especially WARFARIN.  Also tell us if you have any allergies.

Undressing

You will be asked to remove enough clothing so that we can clearly see the part of your body involved.

Marking

The area of skin to be removed will often be marked with ink.

Operating Couch

Apart from exceptional circumstances such as immobility or breathlessness, all patients will be treated lying down on an operating couch.  This makes the operation easier and allows us to use a good overhead light to see clearly.

Local Anaesthetic

The anaesthetic is injected just under the skin around the area to be removed.  It causes a sharp sting which lasts 5 – 10 seconds.  The operation will then be pain free.  Please let us know if you feel any discomfort or have previously experienced any difficulty with local anaesthetic.

For children a local anaesthetic cream (EMLA) can be applied under an occlusive patch two hours pre op. to lessen the discomfort of the injection.

The following information is for those interested in the type of anaesthetic used.  1% or 2% Lignocaine combined with 1 in 80,000 adrenaline is usually used.  This combination provides very rapid numbness and also some vasoconstriction (closing off of small blood vessels) which helps to reduce bleeding.  In some areas such as fingers and toes the adrenaline is omitted from the anaesthetic.  This is done to prevent any circulation problems.

Surgery

Will be performed by Dr Ali with particular experience in Dermatological Surgery.  A nurse will be in attendance.

Stitches

Most minor operations will be very small and the skin will be repaired using a few skin stitches.  The stitches will not be dissolvable and will need removing.

In a few cases where the wound is larger, we may need to use some deep dissolvable stitches in addition to the skin stitches.  This is done to give strength to the repair and also to help draw the skin edges together.  These will dissolve over the next few weeks and may sometimes work their way to the skin surface forming a spot on the scar-line.  They feel a little like a bristle and may need to be removed by my nursing staff.

Stitches will be left in plate for between 1 and 2 weeks.  As a rough guide, in quick healing areas, e.g. the face, they will be removed after one week.  Stitches in areas overlying large muscles, e.g. back, thighs, will be removed after 2 weeks.

Strapping

All stitched wounds will be well strapped up with special dressings.  We advise you to leave our dressings in place if possible until the stitches have been removed.  After the stitches have been removed, we will re-apply strapping which should be left in place for a similar length of time.

The newly healed wound takes several weeks to gain strength and care during this time will improve the final appearance of the scar.

Sports and strenuous activities may stretch the scar and should be avoided for a few weeks.

Stitch Removal

You will be asked to make an appointment for your stitches to be removed at the hospital.  You and your GP will both be notified of the results of the laboratory test (histology).  This normally takes 10 – 14 days.  For many small lesions no follow-up appointment will be necessary as long as histology confirms the expected diagnosis and as long as everything heals satisfactorily.  Following diagnostic biopsy or when further treatment is required you will have been asked to make a follow-up appointment with the doctor who referred you for surgery.  When no follow-up is needed, it is often worth revisiting your own General Practitioner after three months so that he can check that everything has healed satisfactorily.

PROBLEMS THAT CAN OCCUR

Inflammation

Normally a slight redness around the stitches.  This usually settles down on its own when the stitches have been removed.

Infection

Sometimes the treated area can become infected.  This gives rise to pain, swelling and redness or there may be some pus present.  If this happens, you should contact our nurses so that they can check the wound and arrange antibiotics (if necessary).

Bleeding

Even a small operation around the eyes is likely to cause some bruising and may give rise to a ‘black eye’.  In other areas bleeding is less likely but can occur, especially following larger operations.  Very occasionally a wound may bleed sufficiently to need re-stitching or a small blood vessel may need re-coagulating.  If you have any concerns, please contact our nursing staff and they will organize to see you as soon as possible.

Fainting

A few people feel faint or sick during or after an operation.  If you let us know that you are feeling faint we will raise your feet and give you some oxygen.  This will make you feel a lot better.  Patients who have fainted will be kept in the department until they feel better and be checked before going home.  Please let us know if you are prone to fainting, before your operation if possible.

Anaesthetic Problems

1. Palpitations can occur in a few people.  The adrenaline in local anaesthetic can give rise to a feeling of rapid heartbeat.  If this happens, a few minutes’ rest before returning home is advised.  If this has happened before, please let us know and we will use local anaesthetic without adrenaline.

2. Allergy to the local anaesthetic is extremely rare.  We have only had one case in the last 10 years.  If you have had problems with local anaesthetic, please let us know.

Scarring

It is impossible to remove anything without leaving a scar.  As a general ruse, the length of the scar is three times the width of the lump to be removed.

1.  Sensation: When the area of skin to be removed is quite large, it may be necessary to cut some small nerves in the skin.  This type of nerve deals with the feeling of touch.  This means you may have a small area of numbness around or just beyond the wound.  Although substantial recovery may occur in time, you can be left with a small permanent area of numbness.

2. Movement: At my Minor Operations Clinics I have never caused any damage to nerves that deal with movement.  There are, however, certain areas, especially on the face, where deep surgery could cause damage to nerves responsible for movement.  I restrict surgery in these areas but there is always a small risk that nerves may be abnormally placed or hidden in among a tumour and could therefore be damaged in surgery.

Any surgery will involve some small risk.  When there is a malignancy the benefits will obviously always outweigh the risks.  Where a biopsy will help to make a diagnosis, this is also true.  For cosmetic operations it is however sensible to be sure that the scar is going to be more acceptable than the lesion to be removed and other inherent risks of surgery will also have to be taken into account.

Minor Operating Charges

Minor operations will incur a hospital procedural charge and a histology charge in addition to my operating fees.  You will be invoiced for operating fees by my secretaries.  You will be billed direct by the hospital for histology and theatre charges.  This should be paid direct to the hospital concerned.

BOOKING A MINOR OPEARTION WITH US WILL BE TAKEN AS CONFIRMATION THAT A CONTRACT EXISTS BETWEEN YOU AND US FOR THE PROVISION OF SURGICAL SERVICES AND HISTOLOGY AND NOT BETWEEN US AND YOUR INSURANCE COMPANY.