Rhabdomyosarcoma Treatment - McKinnon Plastic Surgery

Patient Info

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TRAVELING PATIENTS

We are happy to communicate in English, Spanish, French or German. Patients coming from out of the state and U.S. are offered advice and assistance with transportation, reductions on hotels and other lodging, visa letters, foreign insurance company correspondence, and letters to sponsoring foreign governments. Children and their families are eligible to stay at the…

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International Patients

Body Procedures Post Op Instructions

Breast Augmentation Post-Op Instruction

Cosmetic Facial Surgery Post Op Instructions

Rhinoplasty Post Op Instructions

Operative Information

International Patients

NATIONAL AND INTERNATIONAL PATIENTS

For patients who are paying cash or cash equivalent funds, negotiations can be made with the appropriate hospital for pre-set rates.

For U.S. patients residing outside of Illinois who are covered by Medicaid, it is possible to negotiate rates for care by Dr. McKinnon in Chicago.

Body Procedures Post Op Instructions

Body Procedures Post-Op Instructions

After Abdominoplasty, the patient will usually stay overnight in the hospital and return home the next day with the help of a friend or family. They may shower the day after surgery and will wear a stretchy wraparound "girdle" to protect the area for several weeks. Drains are removed in 5-14 days if in place. Heavy exertion and exercise should be avoided for 6-8 weeks if the abdominal muscles have been tightened during the surgery. They may return to light work in 10-14 days.

After liposuction, the patient requires a family member or friend to take them home and spend the evening with them. They need to wear a girdle for 24 hours a day for 7-10 days, and then 12 hours a day for a month thereafter. They can remove the girdle and shower anytime. They can return to work in 2-4 days, and must avoid heavy exertion for 2-3 weeks. Oozing is expected from the areas of liposuction for approximately 24 hours after surgery. Swelling and black-and-blue are quite obvious for approximately 7-10 days. Sun exposure should be 2-4-sided in the areas of liposuction for 2-3 months to avoid the risk of hyperpigmentation (blotchy color to the skin). The final result may not be evident for 6 months.

Breast Augmentation Post-Op Instruction

Because of drowsiness after surgery, someone must drive the patient home and stay with them overnight.
The elastic bandage is removed by the following morning. The paper tape over the incisions is left in place until it falls off or is removed by the patient or Doctor in one week. The patient may shower the day after surgery.
A brassiere should be worn during the day for two weeks to support the breast. No other dressing is needed. Although uncomfortable for the first 24–48 hours, discomfort is mild for several days. You can return to work after one or two days if desired. Avoid heavy exertion or lifting for 3 weeks.

Risks

Bleeding. Although uncommon, bleeding can occur after surgery. To best prevent this, avoid all Aspirin products and Ibuprofen (Motrin, Advil, etc.) and megavitamin and herbal supplements for two weeks before and after surgery and avoid exercise and excessive arm use after surgery for two weeks. Tylenol may be taken without risk. If a hematoma develops, it is necessary to remove the hematoma in the operating room. No physician’s fee is charged to remove a hematoma. The patient is, however, responsible for anesthesia, operating room costs, and /or replacement of the implant.
Infection. Infection is uncommon after any surgery, including a breast augmentation. If it does occur, however, the implant must usually be removed. It can usually be replaced after three or more months, although additional costs apply.
Scarring. The most common incisions employed for breast augmentation are just at the areolar border or in the fold underneath the breast. Sutures are placed so that no stitch marks are uncommon. There is some black-and-blue for one to two weeks around the incision. There may be some slight crusting along the incision at that time. All incisions become red, raised, and lumpy at one month and then become soft, pale, and flat over the next six to twelve months. Although all scars are visible, they are usually relatively hidden in the normal color and contour of the breast, and most women find the improvement in breast shape and size worth the scar.
Nipple Anesthesia. Although uncommon, temporary or permanent anesthesia (numbness) of one or both nipples or other areas of the breast can follow a breast augmentation. Occasionally, the nipple will be hypersensitive and have a pins-and-needles feeling for several weeks to months after surgery.
Capsule Formation (an unnatural hardness or firmness of the breast). Breast implants do not change in the body, and they remain soft. However, a thin layer of scar tissue forms around all implants. In some women, this sac of scar shrinks and squeezes the implant, like tightening a tube of toothpaste (the toothpaste is soft inside, but the aluminum tube feels firm as the outer envelope is tightened down). This occurs gradually over months. If excessive, the breast shape and consistency can be unnatural. Correction requires re-operation, excision of scar, and replacement of the same or different implants. Sometimes, the breast will become hard again, despite re-operation. If a revision is required months or years after your surgery, you are responsible for additional operating room fees, implant costs, anesthesia costs, and the surgeon’s fee.
Implant Rupture. It is unusual for implants to break, even after significant automobile or other accidents. However, implant rupture does occur occasionally and may require re-operation to replace the implant and the associated inconvenience and expense. If they are filled with saline, the water is simply absorbed within the body, and the breast goes “flat.” If this occurs, the collapsed implant is removed and replaced. If filled with silicone gel, the gel can be forced into the adjacent breast tissue and can cause abnormally firm lumps. This is uncommon. Usually, the silicone gel simply remains within the sac of the scar that normally forms about the implant. The rupture of a silicone implant is often undetectable by physical or mammography examination, requiring an MRI scan to confirm a rupture. Usually, few or no symptoms or problems occur. Once identified, however, the ruptured implant is removed and replaced. The risk of rupture is about 1% per year.

AFTER SURGERY

An ace bandage will be wrapped around your chest at the time of surgery. Leave it in place until the doctor removes it the day after surgery.
After the ace bandage is removed, you may shower as desired. Steri-strips will be present over your incisions. They will fall off after a few days to a week, or may be removed after 7 days. After surgery, you may continue to wear the ace bandage for comfort, or any bra you desire, or go braless. Some women prefer to remove the wire from an underwire bra for comfort for a week or two.
Most strong discomfort is gone in 24-48 hours, but you will be sore for several weeks.
You can increase the inferior fullness of your breasts more quickly after surgery by applying an ace bandage over the top of your breasts. This applies pressure and stretches the skin below.
Most patients will notice a gurgling sound and feel in the breasts for a few days to a few weeks after surgery. This is air, which enters the dissected pocket of the implant at the time of surgery. It is normal and resolves spontaneously. Some patients note a firm “line” under the skin in the fold under the breast for a few weeks. It is not serious or abnormal and will disappear.
If you use a smooth implant, 2 days after your surgery, you should start breast massage to stretch the pocket about the implant and decrease the risk of late tight scar (capsule formation), which can create a breast that feels too firm. This should be done 5-10 times a day. Simply push the flat of your hand on the inferior part of your breast, pushing the breast up until it bulges under your collarbone. Then, release the pressure. Repeat this 5 times, 5 times a day. You do not need to get undressed. So that you don’t forget, you might do this every time you go to the bathroom. This massage should be continued for at least 6 months. Massage is not useful for textured implants.

Cosmetic Facial Surgery Post Op Instructions

Cosmetic Facial Surgery Post-Op Instruction

Cosmetic surgery is elective, and cosmetic surgery patients are usually healthy. Most procedures are performed as an outpatient. Occasionally, they will stay overnight in the hospital for the control of pain or nausea, for help in simple daily care, or for observation to prevent or treat a possible complication. Few bandages are necessary. Patients need tender loving care, some assistance with simple wound care, the application of ice or lubricating ointment to the eye, and modest help with the needs of everyday living. When possible, they can recover with help at home.

SURGERY

Many facial procedures are performed as an outpatient and do not require staying overnight at the hospital. However, the patient may choose to remain in the hospital for convenience or, because of the length of the procedure and mild to moderate discomfort, wish to stay overnight in the hospital as a short stay. The primary post-op need is reassurance, intravenous or oral pain medication, and intravenous medication for the treatment of nausea.
Drains may be placed to minimize swelling and facilitate a more rapid recovery.
When lower lid surgery is performed, a single suture may be placed in the lateral corner of each eye to minimize eyelid irritation and help maintain the correct position of the lower lid during healing. These sutures prevent the eye from opening completely but do not occlude vision completely-the patient can see, although the eyelid slit appears temporarily smaller. The sutures are removed within 2 to 3 days after surgery by the doctor.  Because many patients tend to sleep with their eyes open after surgery, a bland eye ointment is applied to the whites of the eye, especially at night while sleeping and in the daytime, as necessary, to prevent irritation. Ice compresses are applied to decrease swelling and increase comfort. Ice and tap water can be placed in a bowl with a washcloth or 4 x 4’s wet with cold water, rung out, and laid across the eyes, replacing them as necessary.
Complications are rare but can occur. A post-operative hematoma — usually appearing as a significant lateral facial and neck swelling, often one-sided and sometimes associated with increasing discomfort — can occur. A hematoma of the eyelid can, on very rare occasions, lead to blindness after lower lid blepharoplasty.

AFTER SURGERY

Sleep with your head up to decrease swelling.
Shower and shampoo on the day after surgery. If the drain is still in place, do not shampoo until it is removed.
Apply a cold, wet washcloth across the eyes to soothe the area, decrease swelling, and cleanse any stitches or crusts.
Wash the incisions with soap and water each day. Ointments such as Vaseline, Aquaphor, or bacitracin can be applied if desired. They are not normally applied within or near the hair to avoid messiness.
If a facelift is performed, use a small pillow or folded towel behind the neck when in bed or sleeping rather than a large pillow. It is important to keep the chin up and the neck extended to prevent the folding of neck skin onto itself after a facelift. Avoid flexing the neck onto the chest. When watching TV or reading, keep your chin up, not down. Do not watch television or read in bed with the chin on the chest. Read a book elevated on a book stand or with your elbows on your knees so that your chin remains extended.
Expect facial swelling to increase for 48-72 hours. It will then gradually decrease over a few days to 10 days.
Apply a bland lubricating eye ointment at night and bland saline eye drops during the day, if needed, to lessen eye irritation. These are available without prescription from any drugstore. Applying ointment to the whites of your eyes each night and when sleeping prevents irritation. A temporary stitch is often placed to partially close the eyes so they do not open fully for a few days. It is removed one to two days after surgery. Blurry vision is common after eyelid surgery for a few days.
Use water and very diluted Johnson’s “no tears baby shampoo” as a soap to clean your eyelashes and around the eyes.
If a lower lid blepharoplasty is performed, massage the lower lid 5 times a day by placing the index finger on the skin of the lower lid just above the cheekbone and under the eyelashes. Push in and up to stretch the lower lid skin to cover the pupil. Then, release the pressure and let the eyelid fall back. Lift and apply pressure 5 times a day. This massage is started two days after lower lid surgery and is continued for 4 weeks or longer. This massage helps decrease postoperative swelling and improves healing and eyelid position. Do not pull the eyelid down, only up.
You can apply makeup to normal skin to cover bruising whenever you wish, but do not apply makeup on incisions until they are completely healed. Use makeup that is easy to remove without excessive rubbing.
Expect numbness of the facial skin and any area of facial surgery for months after surgery. You will notice mild tenderness and firmness in the area of surgery for months.

Rhinoplasty Post Op Instructions

Rhinoplasty Post Op Instruction

For the first few days, you may apply an ice-cold wet washcloth across your eyes to decrease swelling and discomfort. Some patients prefer to put crushed ice in a baggy or use a bag of frozen peas.
Expect a runny, slightly bloody nose for a few days. Many patients have a slightly “runny nose” for weeks after surgery. Your nose will be “stuffed” for several days to weeks due to internal swelling and crusting.
Do not remove the nasal splint or tape. It will be removed by Dr. McKinnon in 7 days. Keep the splint dry. But you can wash your face and hair in areas away from the splint.
Cleanse your stitches and nostrils with a wet Q-tip several times a day, and apply Vaseline to the nostril opening and any visible stitches.
Do not blow your nose for 10 days. If the nose is blown, air may be forced into the nasal incisions, puffing the skin and increasing the risk of injury or infection. If you need to sneeze, open your mouth and let the air exit your mouth.
Saline nose drops can be used to decrease crusts within the nose. They are available over-the-counter in any drugstore. Instill several drops throughout the day in each nostril. Put your head back and let the drops run in. “AYR” is a common brand name.
You may notice a slightly bloody ooze from under the taped splint near the corner of the eye. This is normal and not a concern.
You can apply makeup to normal skin to cover bruising, but don’t put makeup on incisions or over crusty areas until completely healed and crusts are gone. Use water and very diluted Johnson’s No Tear baby shampoo and soap to wash your eyes and eyelashes to remove any crusting.
You will have numbness at the tip of your nose for 6 months to one year.
Most bruising and grossly visible swelling disappears in a week to 10 days, but it takes months for things to “settle” completely. Your nose will change for at least 6 to 12 months — becoming smaller and narrower.

Operative Information

Surgery is a team effort. If you wish to achieve the desired result and avoid complications, you must follow instructions. They are provided here for your benefit.

BEFORE SURGERY

Soap and water cleansing before your operation is the most important factor in avoiding infection. Bathe or shower routinely each day, with special attention to the area of surgery. Wash or shampoo the area of surgery the day before your operation. Special soaps or shampoos are not required and may irritate your skin. Use Ivory or Dial soap or your usual soap.
Do not wear facial cosmetics on the morning of surgery. Hair coloring and/or a perm can irritate incisions if they are applied just before or after surgery. If you are having facial surgery and the incisions will be in or near your hair, have your hair colored or have a perm at least one week before and not two to three weeks after surgery.
Do not eat or drink anything after midnight in the evening before surgery. Your stomach must be empty at the time of surgery. You may take prescribed medications by mouth with a sip of water on the morning of the surgery. Examples would be medications for your heart or high blood pressure, or prescribed antibiotics. If your surgery is scheduled in the late afternoon, ask the doctor’s office if a light early breakfast can be permitted and at what time. If you break these rules and eat or drink before surgery, the anesthesiologist will cancel the operation.
If you are going home after surgery, make arrangements to have someone drive you to and from the hospital. Because you may be drowsy, a responsible adult should be available to help you with meals, medication, and assistance to the bathroom, if needed, on the night of surgery. If you stay overnight in the hospital, someone will still need to drive you home the next day.
Have your prescriptions filled, and take the medications as directed. Some discomfort follows all surgery. Pain medication should be taken as needed to relieve pain. If it hurts, it makes sense to take the pain medication. If it does not hurt, you do not need to take the medication. Most often, pain is greater at night than in the daytime, and pain medication may allow more restful sleep. Pain pills can increase nausea, so only take what you need to be comfortable.

When needed, antibiotics are prescribed to prevent or treat infection. They are worthless if not taken as recommended. Follow directions. Take them as long and as often as directed.

Do not take any Aspirin or medications containing Ibuprofen (Motrin, Advil, etc.) for two weeks prior to surgery. Read all labels and check to see that they do not contain these medications. Many over-the-counter medications and other non-steroidal anti-inflammatory drugs do contain Aspirin or Ibuprofen. Avoid them. Most vitamin supplements and herbal remedies also increase bleeding and should be stopped 2 weeks prior to surgery. A daily multivitamin is safe and can be taken, however. You may take Tylenol for minor aches and pains before an operation because Tylenol is not associated with an increased risk of bleeding.
All asthmatics must bring their inhalers with them on the day of the surgery. It is uncommon for anesthesia to worsen asthma, however.
Wear comfortable clothes to and from surgery. Avoid pullover blouses, tight pants, or high heels. These types of clothing are difficult to put on or take off after surgery. Wear flat shoes. A front-closing dress is best for women.
If you are spending the night in the hospital, bring a nightgown or pajamas, toiletries, etc. Do not bring your valuables. Personal items supplied by the hospital may incur additional charges to you.
If you have any questions, ask!

Surgery is a team effort. If you wish to achieve the desired result and avoid complications, you must follow instructions. They are provided here for your benefit.

AFTER SURGERY

Take medications as ordered for pain, nausea, and infection. It is best to take them with something in your stomach. Expect some discomfort and difficulty sleeping for the first 24 to 48 hours.
After surgery, start taking liquids at first and increase your diet back to normal as tolerated.
Rest. Resume light, normal activity as you feel better. Avoid aerobics, weight lifting, or other vigorous activity for two to three weeks after surgery to prevent late bleeding or injury to your recent incisions. Abdominal muscle surgery or other muscle surgery requires a six-eight week period before heavy exertion.
If dressings are applied, they will usually be removed within 24 hours. After the dressings are removed or if no dressings have been applied, you can wash your incision in the area of the surgery on the day after surgery. You can wash your incision and shampoo your hair with your normal shampoo and soap at that time. Special medicated soaps and shampoo are unnecessary and may irritate your skin. After surgery near the eyelid, it is helpful to dilute a drop or two of Johnson’s Baby Shampoo in a cup of water and use that mixture to gently wash about your eyelids by wetting a finger or a Q-tip. This is a gentle way to remove crusts and wash about the eyes without causing eye irritation. Do not put make-up on incisions until your sutures are removed, and all crusts are gone. You may, however, put make-up on other areas of uninjured skin, but remove it carefully without excess rubbing, which could pull an incision apart or stretch the scar.
If you have incisions in or near your hair, do not color or perm your hair until two to three weeks after surgery. However, you can wash your hair with your usual shampoo the day after surgery.
It is usually best to keep facial incisions or an area of dermabrasion greasy with ointment. All incisions ooze for the first 24 hours, and the ointment softens the crusts and allows them to be easily removed with soap and water several times per day. You can use Bacitracin (available at drugstores without a prescription) for a day or two after surgery if you are not allergic to it. After that, use Aquaphor or plain Vaseline instead. Patients frequently develop allergies to medicated ointments after a few days, so we ask you to switch to Aquaphor or plain Vaseline after 1 to 2 days. You do not need to put ointment on incisions along or in your hair.
If you stay in the hospital overnight, the doctor will see you in the hospital before you go home in the morning.
If you have any questions, ask!

COMPLICATIONS

The goal of surgery is to create the desired appearance and function without complications. Most often, the results of surgery are good, and both the patient and physician are happy with the result. However, complications occasionally can and do occur. Unlike a carpenter who may remodel pieces of wood and simply glue them together, a plastic surgeon must “work” with living tissue. The human body has been miraculously formed with the ability to coagulate its blood vessels (stop bleeding), fight infection, and heal itself (normal wound healing). A medieval surgeon once said, “I care for the patient, but God heals.” A surgeon can perform a procedure in the standard way, but it is still your body that must heal itself. The surgeon performs an operation to modify living tissue to a more advantageous state, but the body must heal itself. Occasionally, unforeseen problems occur. Any complication can slow healing, increase scarring, and occasionally require further surgery for correction or decrease the overall long-term result. If further surgery is needed to treat complications, additional hospital, anesthesia, and medical costs may follow. You will be responsible for these additional costs.

Complications which can occur with surgery include:

Bleeding – Any time an incision is made, bleeding can occur after surgery. This usually occurs within the first day or two and is best avoided by not taking Aspirin, aspirin-containing products, or Ibuprofen products (Advil, Motrin, etc.) for two weeks prior to surgery. These medications interfere with the platelet clotting mechanism of the blood and make excessive postoperative bleeding more likely. Herbal and vitamin supplements also increase the risk of bleeding and should be avoided for at least 2 weeks prior to any operation. Also, heavy exertion, straining, aerobics, weightlifting, or other similar exertions should be avoided for approximately two to three weeks after surgery. Because abnormal amounts of blood can interfere with healing, another unplanned operation may be required to wash out the clotted blood if excessive bleeding occurs. This will increase the cost of surgery.
Infection – Any time an incision is made, it can become infected. This is uncommon. If the wound does become infected, it may respond to oral antibiotics, which you can take at home, or occasionally require intravenous antibiotics and admission to the hospital. If an implant is used (breast augmentation or reconstruction, nasal or chin implant, etc.), the implant must usually be removed. Some months later, it can usually be replaced. But the operation must be repeated, and the final result may be less than expected.
Scarring – Any time an incision is made, the wound heals with a scar. Scars are always visible, although they need not be deforming or obvious. All scars become red, raised, and lumpy about a month after surgery. Then, they become soft, flat, and white over the ensuing six months to a year. Such temporary redness is expected and normal. It is important that you understand that if surgery is performed, there will be a scar that comes with it. Some scars are less attractive than others.
Decreased sensation – Local nerves of sensation are injured during surgery. Most often, the feeling returns and the numbness diminishes over a few months and is sometimes restored almost to its preoperative condition over a year. There is numbness over the lateral face and neck at the time of a facelift, over the brow after a brow lift, over the nose after rhinoplasty, over the lower abdomen after an abdominoplasty, on the breast or the nipple after breast surgery (especially breast reduction), and in the area of any incision.
Decreased motor function – Although quite unusual, motor nerves that go to muscles in the area of any surgery can be injured. This can occur during a facelift or a brow lift. If injured, a decrease in facial smiling or the lifting of the brow occurs. Fortunately, it is usually temporary, and muscle function returns in a few months. Occasionally, it does not.
Skin necrosis – Any time we make an incision, skin that is lifted has a decreased blood supply, can heal poorly, and may occasionally die. This is quite uncommon. It occasionally occurs with surgeries that lift large areas of skin (after a facelift, abdominoplasty, or a breast reduction). This is an unusual circumstance. However, it may be associated with slow healing more scarring, and may require further unplanned surgery to remove the unhealthy skin, improve the scar, or the final result, if possible. It occurs more commonly in smokers, and it is important to stop smoking two weeks before and after surgery. Serious necrosis is unusual but can necessitate additional surgery and limit the final result.
Failure to achieve the desired result – Many factors will affect the outcome of surgery. The surgery must be performed appropriately to achieve full correction of the deformity and the best possible healing. The body must heal itself without bleeding, infection, or excessive scarring. The patient’s own body tissues must be healthy. Obviously, excessive sun exposure may promote the early recurrence of skin cancer or signs of aging. Drinking alcohol, smoking, or fluctuation in weight also causes more wrinkles, excessive skin, and signs of aging. In most circumstances, the body part on which surgery was performed was neither perfect nor ideal. It is unrealistic to expect that it will be perfect after surgery. We can only hope to obtain a significant improvement that makes the surgery worthwhile. However, it is not possible to guarantee the results.
Limitation of exercise – To allow proper healing and avoid excessive tension on the wound or bleeding, heavy exertion, aerobics, weight lifting, or other sports activities should be avoided for two to three weeks after most surgery and for six weeks after abdominal surgery or other muscle surgery.
Revisional (redo) surgery and complications – Occasionally, further improvement can be obtained by revisional surgery. After the wound is healed and the tissues are in the best possible condition, an additional surgery can sometimes make things look or function better than would otherwise be possible. The cost of such revisions (surgeon’s fee, operating room charges, anesthesia fee) is the responsibility of the patient, as are the costs of dealing with the complications.

Again, it is impossible to guarantee the results of surgery. The patient must accept the inconvenience, discomfort, and cost of surgery, the risk of surgery, and the risk of complications. The consultation is an opportunity for both the patient and the physician to ask questions of one another so that they can each understand the problem and the best way to approach it. They must formulate a plan and decide what surgery (if any) is appropriate, understand the pros and cons of no treatment or of various techniques, and make a decision that both the patient and surgeon can agree upon. They must be comfortable with one another, have confidence in one another, and feel that they can work together to obtain the desired result. If these conditions are not met, surgery should not be performed. Remember that it is your responsibility to give the risks and gains of surgery careful consideration. You must be willing to follow instructions and take responsibility for your part in your recovery.