Helping Your Child Heal: Incision Care

Life-Threatening Emergencies

If your child is facing a serious or life-threatening emergency, please call 911 immediately.

Keeping Your Child's Incision Clean After Cardiac Surgery

Incision Care

If your child has surgical skin glue:
- Your baby's incision may be closed with non-dissolvable stitches or dissolvable stitches +/- a clear skin glue.
- The skin glue will naturally loosen as the incision heals. You can expect it to last anywhere from 5-14 days.
- Do not let your child pick or scratch at the skin glue or incision site.

Non-dissolvable stitches will need removal by a healthcare provider about 10-14 days after placement.
Always wash your hands before touching the incision.
Keep the incision clean and dry.
Avoid submerging the incision in water.
A cover/dressing is not always necessary.
- Reasons to cover your child’s incision with a bandage:
  - Your child’s chin rubs the top of the incision
  - Your child spits up, drools, or scratches at the incision
- Then you should apply a clean, dry dressing and change it daily.
Protect the incision from direct sunlight for one year by using SPF 30+ sunscreen.

Monitoring

Check the incision daily for redness, swelling or drainage, which may be signs of infection.
Contact the Cardiac Surgery team if you notice any signs of infection.

Bathing

For bathing, use a sponge bath or an infant tub with water only covering the lower body.
Use a clean towel just for the incision site. Do not use the same towel you use for the rest of your child’s body.
Prevent direct water pressure on the incision.
Wash around and gently over the incision with water and promptly pat dry, avoid rubbing.
It’s important that the incision is completely dry after bathing or cleaning.

Incision Cleaning

Perform incision cleaning daily, regardless of daily baths.
Gently remove any bandage and inspect for changes.
Soak gauze or a clean towel with Vashe (wound solution).
Gently pat the incision with soaked gauze/towel to clean it, avoid rubbing.
Pat dry with a dry gauze or a clean, dry towel.
Apply a new bandage if necessary.
Avoid applying lotion, ointment or powder unless instructed by your healthcare provider.

Common Incision Findings

In children under one year old, it is not uncommon for small reactions to appear at the top and bottom of the incision. This is where the knots are tied, and the body might react to them by pushing the stitch through the skin. This is called a “Spitting Stitch” and there is a picture of it below.
A small, raised bump resembling a pimple, sometimes surrounded by redness, may be seen.
It's not always an infection, although it looks similar.
This mostly occurs three to five weeks after the operation; it is less likely after six weeks when the incision is more stable.
If you notice a reaction like this with your child's incision:
- Take daily pictures and send them to the Cardiac Surgery team email
Apply a warm compress to the area.
Do NOT try to pop or drain the bump.
Clean daily with Vashe and cover with a bandage.
Not all reactions will need antibiotics.
Watch for worsening or spreading redness.
If your child has a fever that doesn't go away with Tylenol, go to the emergency room.
Be patient and give it time to heal.

Keeping Your Child Healthy

For the first six to eight weeks after surgery, it is very important for everyone who comes in contact with your child to:

Wash their hands
Avoid people with contagious diseases or cold and flu symptoms
Your child is more likely to get an infection, so try not to go into large crowds and don’t let strangers touch them for several weeks after surgery
After the one-week post-op appointment, the surgical nurse practitioner will approve your baby’s return to daycare, if there are no ongoing surgical concerns

Diet

Your child's diet will be discussed with you prior to discharge
If your child requires fortification of feeds, a dietitian will review how to properly mix your breast milk or formula

Activity and Exercise

Although the skin may appear healed, the bone beneath (the sternum) takes about six weeks to heal. You will need to observe sternal precautions.
Sternal precautions are usually in place for six weeks. They are used to prevent pulling on the surgical incision and decrease discomfort. They will be discontinued by your doctor during an outpatient follow-up appointment.
Sternal precautions include:
- Do not pull the child by their arms.
- Do not lift them up under their armpits. This puts too much pressure on the incision. Scoop your child up, holding them under their head and bottom when picking them up.
- Do not lift their arms above shoulder height (90 degrees).
- Allow your child to move their arms freely. They will self-limit movements that hurt.
- Anything above shoulder height could feel like a stretch; this is why we do not want to pull their arms up and overhead.
- To dress your child: put the arms through the sleeve while their arms are forward and below shoulder height.
Limit how much they push with their arms.
Skin to skin with your baby is okay immediately after surgery, if you are sitting.
Tummy time on a flat surface is okay when certain lines and tubes have been removed. Your child can go on their hands and knees to crawl. These positions should only be used if your baby is comfortable.
No swimming for six weeks after surgery, or until the sternal bone is completely healed
It is safe and very important for your child to have their car seat straps on while riding in a vehicle. You should place your child in the car seat according to the manufacturer's instructions.

Scar massage is used to control how the scar forms while healing. It can be helpful for one to two years. This will help improve the movement of the scar, decrease the itching and sensitivity of the scar, improve a child’s range of motion and improve the scar’s appearance.

Scar massage should not be started until you are cleared by your doctor.

Should I use lotion?

How long do I massage for?

How do I perform scar massage?

Medications

You will receive a list of your child's medications and an instruction sheet before you go home.

Please check with your child’s pediatrician or cardiologist BEFORE giving any over-the-counter medication.

Immunizations

If your child required the heart-lung machine (cardiopulmonary bypass machine) during surgery:

You may receive the respiratory syncytial virus (RSV), COVID or flu vaccine any time after surgery
Any vaccines given within two weeks BEFORE the surgical date must be repeated
Any other routine childhood vaccines should be given six weeks after surgery

If your child did not require the heart and lung machine during their surgery, the vaccines recommended by your pediatrician may be given as usual.

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