Patient Care Guide
Post-Operative Wound Care
Cleaning, dressings, normal healing, warning signs, scar care, and how to send a photo to your clinical team.
Wound Cleaning — Week 1
Gentle saline cleaning while dressings are in place
🕐 Once daily — or when dressing is soiled
No wetting until the drain is removed. While the drain is in place, sponge-bathe around the wound — do not wet it. Once the drain is out, you may shower over the wound with soap and water. Pat it completely dry immediately afterwards. Never submerge the wound in water.
1
Wash hands thoroughly for 20 seconds with soap and water before touching the wound.
2
Prepare: sterile gauze, 0.9% saline sachets (or cooled boiled water), clean scissors. Have fresh dressing materials ready before removing the old one.
3
Gently soak and remove the dressing. If stuck — do not pull. Soak with saline until it releases freely. Forced removal tears new tissue.
4
Clean the wound with saline-soaked gauze — wipe gently from centre outward. Use a new piece of gauze for each stroke. Never wipe back over a cleaned area.
5
Inspect the wound — see Normal vs Warning tab before applying new dressing.
6
Apply fresh dressing: non-adherent layer (Mepitel or paraffin gauze), then absorbent pad, then secure with tape. Snug but not tight.
Key tip: Mepitel or Jelonet as the contact layer prevents the dressing sticking — the most important layer. Never put plain cotton gauze directly on an open wound.
Intraoral Wounds
Wounds inside the mouth — after oral cavity surgery
Intraoral wounds heal in a wet, bacteria-rich environment. Healing is fast (the mouth has an excellent blood supply) but infection risk is higher. Consistent mouth care is essential.
1
Mouth rinses every 4 hours: dissolve 1/2 tsp salt + 1/2 tsp baking soda in 200ml warm water. Rinse gently 30 seconds. Start day 1, continue 6 weeks.
2
Prescribed chlorhexidine 0.2% mouthwash — use as directed (typically twice daily for 2–4 weeks). Do not use beyond prescribed duration without review.
3
Diet: follow the phase directed by your team — liquid progressing to soft. Avoid hard, sharp, or spicy foods until the wound is healed.
4
Dental hygiene: continue brushing remaining teeth with a soft toothbrush twice daily — avoid the surgical site directly for the first 2–3 weeks.
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Warning signs inside the mouth: white or yellow coating (possible oral candida) › foul odour › swelling suddenly increasing › bleeding not stopping after 10 minutes of firm pressure.
✓ Normal healing
- Wound edges held together
- Mild-moderate swelling — peaks day 2–3 then reduces
- Bruising (purple/yellow) fades over 10–14 days
- Pinkish-red uniform colouration
- Small amount of clear or pale straw-coloured fluid
- Itching — a reliable sign of healing
- Mild to moderate pain — controlled with analgesia
- Suture line crusting in week 1 — normal
- Numbness around wound — common after neck dissection, improves over months
- Tight or pulling sensation — scar tissue forming
⚠ Contact the team
- Wound edges separating — any gap (dehiscence)
- Yellow-green thick pus or foul smell
- Redness spreading beyond wound edges (cellulitis)
- Increasing pain after day 3
- Swelling increasing after day 3
- Fever above 38°C with wound changes
- Hardening of neck with redness — possible haematoma
- Bright red bleeding — apply firm pressure, call team
- Saliva or oral fluid coming through neck wound (fistula)
- Skin turning dark or black over the wound
What to Expect — Week by Week
Normal healing milestones after head and neck surgery
🌿
Days 1–3
Inflammatory phase
Maximum swelling and bruising. Wound feels warm and tender. Small amount of clear or blood-tinged fluid is normal. Pain peaks then begins to reduce. This phase looks dramatic but is expected.
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Days 4–10
Repair begins
Swelling and bruising reduce. Wound edges become firmer as collagen is laid down. Suture line may have small crusts — normal. Itching begins — a reliable sign of healing. Drain typically removed around day 3–5.
✂️
Days 10–14
Suture removal
Most sutures removed at your outpatient appointment. The wound surface is closed but deeper layers are still healing. The scar will be red and slightly raised at this stage — expected and temporary.
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Weeks 2–6
Scar remodelling begins
The scar becomes firmer and more defined. Redness may intensify briefly before fading. Scar massage and silicone gel begin. Tingling and hypersensitivity are common as nerves recover.
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Months 2–6
Scar softening
Scar gradually softens, flattens, and fades from red toward pink and eventually white. Continues for 12–18 months. Consistent massage and silicone use accelerate improvement.
✨
Month 12–18
Mature scar
Scar reaches final appearance. Most head and neck scars are well camouflaged in natural skin creases. Surgical revision or steroid injection available if scar remains symptomatic.
What is a drain? A closed-suction drain (Redivac) is a thin tube placed under the skin at the end of the operation. It removes blood and fluid that accumulates in the wound space — preventing haematoma and enabling healing. Most neck dissection drains are removed on day 3–5 when daily output drops below 20–30ml.
Drain Care at Home
If discharged with a drain still in place
Most patients do not go home with drains. If you have been discharged with a drain, your nurse will have given specific instructions. This guidance applies only if a drain is present.
Important — showering and the drain: Do not wet the wound or shower over it while the drain is in place. Once the drain is removed, you may shower over the wound with soap and water — pat it completely dry immediately afterwards.
1
Empty twice daily (or when bottle is half full). Wash hands. Tilt bottle, open port, empty into toilet, measure and record volume and colour. Close port — squeeze bottle before closing to re-establish suction.
2
Record daily output — date, time, volume (ml), and colour at each emptying. Bring this record to your outpatient appointment. It determines when the drain is removed.
3
Keep the tubing secure — pin to clothing inside your shirt. The drain must not pull or be at risk of accidentally coming out.
4
Clean the drain site gently with saline once daily. A small amount of clear fluid around the exit site is normal. The tubing should move freely without excessive pain.
Drain output colour guide
Clear / pale yellow
Serous fluid — normal. Volume reducing. Progress toward removal.
Pink / light blood-tinged
Serosanguinous — normal in first 48 hours. Should clear over days.
Bright red — small volume
Monitor closely. Output >50ml/hr of bright red — call team immediately.
Output suddenly increases
After decreasing trend — possible haematoma. Call team same day.
Milky white / cloudy
Possible chyle leak (after neck dissection). Call team today.
Drain has come out
Cover site with clean gauze. Call team immediately. Do not reinsert.
When to start: Begin scar care when sutures are removed AND the wound surface is completely closed — no scabs, open areas, or moist patches. Typically 2–3 weeks after surgery. Starting too early risks infection.
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Scar Massage Timer
5-minute session. Apply firm circular pressure with fingertip along the scar. The scar should whiten then re-pink — this is the correct pressure level.
Scar Massage Technique
The single most effective scar intervention
🕐 Twice daily — 5 minutes each session
1
Apply moisturiser, vitamin E oil, or silicone gel to your fingertip before starting. Reduces friction and allows smooth movement over the scar.
2
Circular technique: Place the pad of your index finger on the scar. Apply firm pressure — enough to blanch (whiten) the skin briefly. Make small circular movements along the length of the scar. The scar should whiten under your finger then pink again when you lift.
3
Cross-fibre technique: Place two fingers across the scar line. Move the skin up and down, then side to side — you are moving skin over deeper scar tissue. This breaks down adhesions and prevents the scar attaching to deeper layers.
4
Lifting technique (months 2+): Pinch the scar gently between thumb and forefinger and gently lift and roll the scar tissue away from underlying structures. Effective for scars that feel fixed or tethered.
5
Cover the entire scar systematically. Spend extra time on areas that feel thickest or most restricted. Use the timer above.
Scar massage should be slightly uncomfortable — not painful. Mild discomfort, tightness, or a pulling sensation indicates adequate pressure. Sharp pain — reduce pressure.
Scar Products — What to Use and When
Evidence-based guide
From week 2
Silicone gel (topical)
Apply thin layer along scar twice daily after massage. Allow to dry 2–3 minutes. Brands: Dermatix, Kelo-cote, Scar Away. Minimum 6 months.
From week 3
Silicone sheeting
Adhesive sheets worn 12–24 hours daily. Particularly effective for raised or hypertrophic scars. Wash daily, reuse up to 30 days. Best results at 3+ months.
From week 2
Moisturiser
Aqueous cream, E45, or coconut oil. Applied after massage — keeps scar supple and reduces itching. Any fragrance-free moisturiser is suitable.
From week 2 outdoors
SPF 50+ sunscreen
Every morning to the scar without exception. UV causes permanent hyperpigmentation of healing scars. Continue for 12 months from surgery.
Month 3+ if needed
Steroid injection
Intralesional triamcinolone for hypertrophic or keloid scars — by your surgeon. Highly effective. Typically 2–4 sessions at 4–6 week intervals.
Month 12+ if needed
Laser treatment
Fractional CO2 or pulsed-dye laser for persistent red or textured scars. Discuss with surgeon at 12-month review.
Sending a wound photo allows the team to assess your wound without a clinic visit — particularly useful for checking whether a wound change is concerning, monitoring scar progress, or identifying early complications.
Send Wound / Scar Photo
Fill in your details, add a photo, then send via WhatsApp
Photo (strongly recommended)
Tap to take photo or choose from galleryMobile: opens camera directly • Desktop: choose a saved photo file
Tips for a good wound photo
- Good lighting — natural daylight is best. No shadows over the wound.
- Hold camera 15–20cm from the wound — close enough to see detail clearly.
- Keep camera still — blurry photos cannot be assessed.
- Take 2–3 photos — one close-up and one showing the full wound and neck.
- For neck wounds — chin slightly up gives the best view of the suture line.
Message preview
Fill in your details above to generate the message.
After tapping "Open WhatsApp"
- WhatsApp opens with the message pre-written — do not delete it.
- Tap the 📎 (attachment) icon in WhatsApp.
- Select your wound photo from the gallery or take a new one.
- Tap Send.
- The team will respond within 4 hours during working hours.
Daily Wound Care Schedule
Phase-specific tasks
Never hesitate to contact the team about your wound. Early assessment is always better — most complications are much easier to manage when caught promptly. Send a photo if you are unsure.
WhatsApp Clinical Team