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Dealing with paediatric plastic surgery concerns

In this unprecedented time in medicine, we have been required to drastically limit patients coming to hospital to reduce the footfall and protect staff and patients.

Although routine outpatient appointments may well be postponed for six months or more, we will endeavour to communicate with patients and families should there be an acute need. Initially this will be via telephone, internet communication or if absolutely necessary a face to face urgent appointment.

Below consultant paediatric plastic surgeon Mr Nicholas Wilson Jones has put together some general advice and information on dealing with concerns related to specific conditions that child patients may experience.

If your son has had hypospadias surgery within the last month and is troubled either with redness or wound breakdown, or if you feel he has difficulty in passing urine, then please take a photograph of the required area and contact my secretary on the telephone number listed in the contact us section of this page. 

We will find a safe way for the images to be looked at and I will contact you either via telephone or email to advise. 

If I feel it is necessary, the appropriate dressings and prescriptions can be sent through the post and we can hopefully follow your son’s progress healing with regular photography.

If your son is under regular follow up that is normally either annually or bi-annually, then we would want to hear from you if there are signs that he is developing a possible stenosis (narrowing of the reconstructed urethra) or a fistula (second opening or leak from the newly reconstructed urethra). 

Signs that there may be a potential stenosis or narrowing of the tube would be that your son is having recurrent urinary tract infections (UTI) or complaining of urgency (sudden desire to pass urine despite having been recently), or the narrowing and thinning of the stream and incomplete opening of the bladder. 

If your son experiences these symptoms over a protracted period of weeks, please contact my secretary via telephone and we can arrange a telephone or online consultation. 

If your son develops two streams or a leak, please be reassured that as long as he is emptying his bladder, all is well. A very small number of these may heal on their own but most require surgical correction at a later date, but this is not an emergency. Please do however contact us via my secretary and we can arrange a telephone or on-line consultation.

In all other boys that are having standard outpatient follow up with respect to their hypospadias, with a delay as mentioned above, it is safe and appropriate when considering that some surgeons and hypospadias do not continue with long term follow up of any form. If there are any worries or concerns, please do not hesitate in contacting my secretary and we can try and arrange a telephone or on-line review. 

If you or your child is awaiting an appointment or surgery, sadly things will be significantly delayed.

Please contact us if there are acute, persistent problems affecting you or your child on a daily basis.

Please be aware that the field of vascular anomalies covers a huge range of different pathologies. Below is some basic advice with respect to the most common.

If you or your child is awaiting an appointment or surgery, sadly things will be significantly delayed.

Please contact us if there are acute, persistent problems affecting you or your child on a daily basis.

Infantile Haemangioma

For those parents who have children with infantile haemangioma (strawberry naevus or strawberry birth mark), the vast majority, as would have been explained to you in the outpatient setting, will involute (disappear) over the first few years of life but with only 50% involuted by the age of 5, 70% by the age of 7 and 90% by the age of 9.  

If your child has a complicated haemangioma, we may have started, in combination with our paediatric colleagues, using the drug Propranolol. Propranolol should be continued and the dose increased as your child grows. 

If your child is on Propranolol at present then we can, together with our paediatric colleagues, organise incremental increases in the dosage as long as we have an accurate weight for the child. This can be done via telephone or on-line consultation.

You would already have been given advice concerning the issues to watch out for when your child is on Propranolol and if there are any significant issues then please contact the doctor who is providing the Propranolol therapy or myself via my secretary and we can arrange the appropriate review. If you have any serious complications, please do not hesitate in contacting your local emergency department. 

Venous Malformations

A significant number of patients have venous malformations which are under longer term review. A number of you will be under joint review by myself and the lymphoedema team and may well have pressure garments, which should be worn as you have directed. 

Occasionally, within venous malformations, small painful areas can develop. As soon as this occurs, simple analgesia will reduce the inflammatory process and reduce the level of discomfort which normally settles within 5-7 days. 

If there is prolonged pain or discomfort, or you feel the limb is significantly swollen, then please contact us immediately when we can arrange either an online review, via telephone or if absolutely necessary face to face. 

Lymphatic Malformations

If you or your child is suffering from lymphatic malformation, you may be under the joint care of myself and the lymphoedema team with pressure garments. You should continue to use those as prescribed. 

If you experience small bleeds into the tiny vesicles in the skin, these are normally self-limiting. You should use conservative measures with a non-stick dressing and contact us if they continue. 

Patients with lymphatic malformations are less resistant to localised bacterial infections of the skin, therefore if you experience any spreading redness within or round your lesion, then you might be experiencing a localised infection. Please take a photograph and we can provide a safe way to review the images and potentially post you a prescription or offer advice without the need for a face to face review.

If you are unwell with redness and a high fever please urgently contact your local accident and emergency department. 

Arteriovenous Malformations

If you or your child is being treated for a true arteriovenous malformation, then hopefully you will be following the advice that we have provided in clinic. 

If you have an acute episodes of bleeding, direct pressure for three minutes initially and then review. If still bleeding, repeat for a further three minutes. If the bleeding continues, you will need to attend your local accident and emergency department.

If your lesion is growing rapidly and giving you cause for concern or if you have recently become pregnant please contact my secretary and we can arrange an online or telephone review. 

If you have had surgery recently and there is redness or wound breakdown, please take a photograph of the area and we will arrange a safe way for it to be reviewed. We will then arrange either an online or telephone consultation. We can always provide a prescription for dressings and antibiotics if required. 

If you child is unwell with a high temperature please attend your accident and emergency department.

If your child has had an operation for a skin lesion in the last few months, please rest assured that we will be accessing the histology (microscope analysis) of the lesion and either writing or telephoning you with the results. We rarely use stitches that require removal in children, so once the dressing has fallen off, please just bath or shower the wound as you would normally.

Moisturise with Vaseline or E45 and massage firmly, as this will help promote healthy scarring. Please keep the pink scar protected from the sun with a high factor sun block for the first year.

Six weeks to three months following the operation, the scar may look slightly raised, red and itchy and this is normally a transient phase and will continue to settle with moisturisation and massage but scars can take 18 months to reach full maturity (best cosmetic result). If the red itchy, lumpy phase continues or is problematic, then please contact my secretary using the details listed in the contact us section of this page and we can arrange a telephone or online consultation. 

If yourself or your child has had an operation for a skin or soft tissue malignancy, then you will have a formal online or telephone consultation but this may not be on the specific day that it has already been booked. Please contact my secretary and we can discuss the appropriate method of review. 

If you or your child is awaiting an appointment or surgery, sadly things will be significantly delayed.

Please contact us if there are acute, persistent problems affecting you or your child on a daily basis.

If your child has had surgery to correct differences to upper and lower limbs that they were born with in the last 4-6 weeks (January-March 2020) and there is a problem with wound breakdown or redness, then please contact my secretary using the details listed in the contact us section and we will arrange an appropriate online or telephone review. We can always send prescriptions for antibiotics or dressings as required.

If your child or yourself has had surgery to a congenital limb anomaly and are in long-term follow up, then please contact my secretary if there are acute issues or concerns that are affecting you on a daily basis. If these concerns require it, then I will arrange an acute telephone or online consultation.

If you or your child is awaiting an appointment or surgery, sadly things will be significantly delayed.

Please contact us if there are acute, persistent problems affecting you or your child on a daily basis.

If you would like to contact Mr Nicholas Wilson Jones, please go via his secretary Suzanne Thomas.

Email: Suzanne.thomas@wales.nhs.uk 

Telephone:  01792 703568

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