What are the post-operative care instructions for a patient after a dorsal slit procedure?

Post-Operative Care for Dorsal Slit Procedure

Keep the surgical dressing in place for at least 48 hours post-operatively unless leakage occurs, use topical antibiotics and analgesics for pain control, and schedule follow-up at 7 days for wound assessment and at 4 weeks to confirm complete healing. 1, 2

Immediate Post-Operative Management (Day 0-2)

Dressing Care

• Apply an occlusive or semi-occlusive dressing in the operating room and leave undisturbed for a minimum of 48 hours unless visible leakage, bleeding, or soiling occurs 1, 3
• Either sterile gauze or sterile transparent semi-permeable dressings are appropriate for covering the surgical site 3
• If using transparent dressings, they allow continuous visual inspection without removal and can remain in place up to one week unless they become damp, loose, or visibly soiled 3
• If visible exudate or bleeding occurs, gauze dressings are preferable and may require replacement every two days until resolved 3

Pain Management

• Provide topical anesthetic sprays or ointments, acetaminophen, and NSAIDs for pain control 1
• Avoid opioid analgesics if possible due to potential complications including constipation and urinary retention 1
• Local cool packs applied to the surgical site can provide additional pain relief 1
• The dorsal slit technique is associated with more postoperative pain compared to alternative techniques, so adequate analgesia is essential 4

Infection Prevention

• Administer topical antibiotics routinely in the immediate post-operative period 1
• Use proper hand antisepsis and aseptic non-touch technique when changing dressings 3
• Apply 0.5-2% alcoholic chlorhexidine solution during dressing changes for skin antisepsis 3

Urinary Catheter Management

• A Foley catheter should remain in place given the increased risk for urinary retention 1
• Perform a voiding trial on postoperative day 1 to ensure adequate bladder function 1

Early Post-Operative Period (Days 3-7)

Dressing Changes

• After the initial 48-hour period, daily incision washing with chlorhexidine is potentially beneficial for preventing surgical site infections 3
• Change dressings using sterile technique if exudate, bleeding, or soiling is present 1, 3

First Follow-Up Visit (Day 7)

• Schedule the first post-operative assessment at 7 days to evaluate for adverse events related to surgery 2
• Assess for common complications including bleeding, infection, penile edema, and wound gaping 2, 5
• Document wound healing progress and any concerns 1

Activity Restrictions

• Advise patients to avoid sexual intercourse for at least 4 weeks post-operatively to allow complete wound healing 2
• Resumption of intercourse before 4 weeks increases risk of wound complications 2

Late Post-Operative Period (Week 4)

Second Follow-Up Visit

• Schedule assessment at 4 weeks post-operatively to confirm complete wound healing 2
• Complete wound healing at 4 weeks occurs in approximately 84% of dorsal slit patients, though this is lower than some alternative techniques 2
• Evaluate for late complications including skin tunnels (which occur in approximately 9.5% of dorsal slit cases), infection, wound dehiscence, or secondary phimosis 5

Patient Education and Documentation

Informed Consent and Documentation

• Clearly document the laceration type and method of repair, including comprehensive details on the technique and suture used 1
• Inform the patient of the procedure performed and the importance of close follow-up 1
• Provide patients with a written record of their procedure for future medical care 1

Warning Signs

• Instruct patients to seek immediate medical attention for signs of infection including redness, increased pain, purulent drainage, or fever 1
• Monitor for bleeding complications, which may require surgical hemostasis 2

Common Pitfalls and Complications

Expected Complications with Dorsal Slit

• The dorsal slit technique is associated with higher rates of penile edema (approximately 19%) compared to device-assisted techniques 5
• Skin tunnels occur in approximately 9.5% of cases, which is unique to the dorsal slit technique 5
• Postoperative pain is typically higher with dorsal slit compared to alternative techniques, requiring more aggressive pain management 4
• The frenular artery may be injured during dorsal slit procedures due to traction on skin and mucosa, potentially causing increased bleeding and ischemia 4

Monitoring for Adverse Events

• Surgery-related moderate adverse events occur in approximately 0.8-1.0% of cases 2
• Wound healing may be delayed compared to alternative techniques, with complete healing at 4 weeks in 84% versus up to 100% with other methods 2