"My team and I will ensure you are treated ethically, professionally and to the
highest possible standard. We proud ourselves in offering personalised care and going
'the extra mile', from making last-minute scheduling changes to accommodating
your visit and helping with issues that may unexpectedly arise during your treatment."
You might think that in surgery intervention is all that matters, underestimating the importance of us meeting prior to it. The consultation is however, probably the single most important point in your treatment journey, the crux of personalised medical care.
Many conditions might appear similar in different people, but as everyone’s circumstances are different, the optimal therapy will vary from one person to another. Extracting relevant facts and physical examination of the problem, make each and every consultation unique. No technical innovation can (yet) replace values of face to face meeting.
It takes time to have a decent chat in the clinic – understand your concerns, expectations and needs as well as explain medical facts, my advise and clinical preferences. If some sessions require more time than expected, clinics might be delayed, so apologies in advance if I am running late. Your patience is much appreciated as it allows unrushed consultations and as much time as needed for everyone.
Patients inquiring about cosmetic surgery should attend clinic at least twice prior to actual surgery. This has always been my practice, and it is encouraging to see that this has become mandatory by the General Medical Council. Patients are not charged for the second consultation. The delay between two appointments allows “a cool off time” to think through about all the information provided first time (and there is usually a lot to take on board) and to make well informed, unhurried decision.
Your time of arrival will be confirmed in your admission letter. Time of admission does not always determine the time of your operation. Surgical schedule is usually based on a half day (morning or afternoon) operating session. You will be asked to arrive to the hospital at least 60-90 min before you actual operation to allow enough time for formal admissison and preassessment by the ward staff. The flow of each operating list is however, dependant on multiple factors which cannot be always envisaged super accurately in advance. We do always try very hard to minimise your wait on the ward as much as possible.
Once you are admitted to your room, anaesthetist, nurse and I will visit you and amongst other things, ask you to sign a consent form ensuring again that you are happy with all information about surgery and understand it’s implications.
Patients undergoing surgery under general and regional anaesthesia, will be advised not to eat and drink for minimum of 6 hours ahead of your operation. Only clear water is allowed up to 2 hourse before your surgery, but no other drinks (tea, coffee, juices). You will receive written nil by mouth instructions few days before admission to the hospital. In general, patients operated in the mornings are advised not to eat after midnight and have a small amount of clear water only up until 7am. Patients undersgoing surgery in the afternoon, should complete their breakfast by 7am and consume clear water by 11am at the latest.
Patients are usually advised not to drive for a period of time after surgery, therefore you need to somebody to drop you off at the hospital and collect you again on departure.
If your operation takes place under general anaesthetic, you will need to remove any nail varnish, nail extensions and cosmetics beforehand. Jewellery, including body piercings, will need to be removed, especially jewellery on a hand which is about to be operated upon. Surgery might need to be cancelled if we are unable to remove the rings or bracelets as they can pose dangerous compression against swollent tissues post operatively. If you struggle to remove well-fitted rings, please try to get them removed by professional jewellers in advance to avoid us cutting it in the hospital at the last minute.
For operations involving a small body area, it is possible to simply inject local anaesthetic into the skin so that you remain awake throughout the procedure. Injection and infiltration of anaesthetic is uncomfortable, but only for a few seconds. The injection is carried out slowly to minimise any discomfort, and it is reassuring to know that it does work very quickly indeed. It is bearable for the vast majority of patients, even children. The injected area becomes numb within 30–40 seconds.
You will feel no pain following the injection, but you will continue to feel touch and temperature variations during the intervention.
A general anaesthetic is not always necessary or advisable. Regional anaesthesia involves numbing of a targeted area in the body, without the need to put the patient to sleep. In my practice this is commonly accomplished in patients undergoing wrist or hand surgery.
In regional anaesthesia, local anaesthetic solution is administered around large nerves in the armpit so that the whole of the upper limb becomes temporarily numb and floppy. Anaesthesist usually uses ultrasound machine to guide infiltation accuracy. Regional anaesthesia (in hand surgery often known as a Brachial Plexus block) requires time (30-45 min) and specialist expertise. I am glad to confirm that anaesthetists who work with me are all capable to perform this intervention. Effects last for few hours, during which even very complicated and extensive operations can be completed without any discomfort to the patient. Please bear in mind that this will render the whole of the upper limb useless (numb and floppy) for any activities at home. You will probably appreciate help in the first 24-48 hours so try to arrange it in advance.
Fasting is required for regional anaesthesia, in case conversion to general anaesthesia is required during the procedure.
The development of new, safer anaesthetic drugs and sophisticated monitoring equipment means that modern anaesthesia is nowadays, generally very safe. Anaesthesia usually begins when the anaesthetist injects a drug through a fine plastic tube (cannula) placed into a vein on the back of the hand. Within a few seconds, this sends you quickly and smoothly to sleep. It is also possible to induce anaesthesia with anaesthetic gases, inhaled through a mask. To maintain this unconsciousness, the anaesthetist gives you a mixture of oxygen and anaesthetic gases to breathe. This ensures you are unconscious throughout the operation and will not feel any pain or remember anything about it. The anaesthetist will monitor your condition throughout the operation. Sometimes a combination of these can be used. We would normally discuss this in the clinic, depending on individual circumstances, and advise you what to expect well in advance.
If your operation is to be carried out under regional or general anaesthesia you must not eat any food including sweets and chewing gum or have any milky drinks for a minimum of 6 hours prior to the start of your operation. Milk counts as a food product as it takes longer than other fluids to digest. Fasting helps to prevent inhaling (breathing in) the stomach contents into the lungs while unconscious under general anaesthetic. You may safely continue to drink still water up to 2–3 hours prior to surgery. Research has shown that drinking fluids up to 2 hours before surgery helps recovery, and reduces postoperative nausea (sickness) and risk of vomiting.
Because the exact schedule of operations might change up until the last minute due to unpredicted medical circumstances, patients undergoing surgery in the morning are advised to eat only until midnight on the day prior to admission and drink only clear water up until 7am on the morning of surgery. For patients scheduled to have surgery in the afternoon, a light breakfast should be consumed up until 7am and a last clear water consumed by 11am.
You will be advised how long you will need to stay in hospital well in advance of surgery. As a rough guide, after a general anaesthetic you must stay in hospital for at least 3–4 hours so that the effects of anaesthetic can be monitored at regular intervals.
Please be advised that you should not drive your car for at least 24 hours after surgery. You will have to be arrange for somebody to collect you from the hospital. Alternatively we can arrange a taxi or private ambulance for you. If you need to take any medication following your departure, this will be given to you before you leave.
The first postoperative follow-up focuses on wound care and healing and is often carried out one week after surgery. The wound is checked, cleaned and dressings reduced. For wounds on the face and neck, most sutures are removed at that point too. Stitches on the body and extremities wounds are usually left intact for two weeks.
The number of follow-ups needed for each condition is not set in stone. Patients are generally reviewed for as long as there is a clinical need, or if the patient is concerned. Postoperative scars may change for up to 12 months, sometimes even longer. This is why the final outcomes of surgery are often not judged until several months have elapsed after the operation.
Follow-ups are a vital part of your treatment and should be covered by your insurance policy. For self-paying patients, most follow-ups are included in the packaged price and inclusive of as many reviews as clinically necessary.
Naturally,we trust your judgement and genuine concerns in attending the clinic as and when required. In the event that more than the usual number of reviews are envisaged, due to the complexity of particular medical problem, you will be advised in advance.
The local anaesthetic will wear off after about 2–4 hours; if you experience any pain or discomfort following the procedure this may be relieved with a painkiller, e.g. Paracetamol, rather than Aspirin, but this is truly very rarely required.
The original dressings that we provided you with at teh time of surgery, very often needs to be changed within the first week. We often provide you with spare dressings to take home and replace if necessary between 2-4 days after surgery. As long as the wound is reasonably dry and dressings are not too messy, it is fine to leave things alone until the first planned follow up.
Oozing and blood stain on the dressings are normal and expected. Finger pressure over the operated area 15–20 minutes immediately after the procedure prevents imminent bleeding and tissue swelling, so all patients are shown how to do that before leaving the operating theatre.
Most patients should be able to drive straight after minor skin procedure, except in case of eyelid surgery.
Dressings are designed to contain and absorb a small amount of discharge from a wound. However, if dressings get completely soaked and stop adhering to the skin at any time after surgery, they need to be changed. If you are not comfortable with doing this at home or do not have spare dressings, the nurses in the hospital where your operation took place are always available to help.
In most instances, the dressings applied in the operating theatre stay on until you are reviewed in outpatients. Nurses are most likely to check on your wound and exchange dressings at 7 days. Review by me is most commonly scheduled at 2 weeks, in line with insurance companies approval. This interval might be shorter after skin grafting or flap reconstruction.
Some wounds are closed with dissolving sutures, others with non-absorbable ones. The decision as to which stitches are to be used is based on a variety of clinical facts, but also on patient preference whenever appropriate. We usually discuss this advance.
Sutures on the facial wound most commonly stay in place for 10 days. Wounds on the body and extremities need to be supported with stitches for minimum of two weeks. Most dissolvable sutures will disappear from the skin surface within the first 4-5 weeks after the procedure.
If a tissue biopsy is taken, the specimen will be sent to the histopathology laboratory for processing. The results of sample analysis are normally available within 3-5 days of your surgery, in urgent cases after 24-48 hours. In most cases, results are discussed at the first follow up appointment, when the wound is checked and sutures removed.
Cost of histopathology service is between £180 – 220 and this is charged separately. Insurance companies normally cover this expense. Self funding patients will be advised about this cost ahead of the intervention.
Following operation, your hand will be bandaged with wool and crepe, for at least 2-3 days depending on exact type of procedure that you had. The dressing minimises swelling and makes you feel more comfortable as the wound is protected and the hand gently immobilised. The bandage should remain intact and dry for 2-5 days and I will specify the duration after operation as this varies between the procedures. Your hand should be elevated, especially in the first 48 hours so that the wrist is above elbow level. A sling will be useful in obtaining this during daytime whereas at night, keep you arm well elevated on pillows. Please remember not to keep the hand hanging down! That would make pain worse and hand puffy and swollen.
You might experience mild pain/discomfort once the local anaesthetic has worn off (most commonly 4-6 hours after the operation). Feel free to take the painkillers (like paracetamol or co-codamol), but according to the majority of patients, this is very seldom required.
If you have regained full movement and are reasonably comfortable without the dressings, you may drive car after one week. You should not drive whilst your hand is bandaged and splinted. It is therefore essential to have someone to drive you home and help while you arm is in a sling.
At no time after surgery your fingers should become numb, cold or discoloured. If you experience any of above mentioned symptoms please do not hesitate to contact the hospital wher you have been operated.
Your wound should heal within 12-14 days. If non-absorbable (non-dissolving) stitches have been used the nurse will advice you when and where to have the sutures removed. If the wound has been closed using an absorbable/dissolving stitches, only wound check will be arranged, usually with your GP, after 7-10 days.
Remember to move your fingers, elbow and shoulder joints in order to prevent stiffness. Within the hand bandage, try the following finger exercises as soon as possible:
- straightening the fingers completely
- making a claw and a fist with the fingers
- spreading the fingers as wide as possible
- touch each of your fingertips with the tip of your thumb
Although the wound heals within the first two weeks after surgery, the scar continues to change for up to 12 months. In the first 6 weeks it is often pink/red, firm and tender. This is normal and a regular use of (a simple skin) moisturiser and scar massage might speed up the scar maturation and your recovery. Scar washing (soap and water) and moisturising is encouraged as soon as the wound has healed.
Please remember that without adequate hand therapy, your long-term outcome can be truly compromised and recovery delayed.
You are likely to be seen by one of Hand therapists 3-6 days after surgery. Therapist will exchange Plaster of Paris applied at the time of surgery for the custom-made, lightweight splint which you can easily put on and remove at home during the subsequent few weeks.
The aims of therapy are to protect tissues while they are healing, but also mobilise them early before adhesions settle leading to stiffness. Supervised physiotherapy also strengthens your fingers, reduces tissue swelling, manages pain, and looks after scars for several weeks.
Many hand surgery procedures require wearing of a splint or cast for few weeks after operation. This may impact on your work and ability to drive so the timing of the surgery needs to be carefully planned. Postoperative protocols are highly individual; dependent on your condition, operative findings and your job duties so you will be advised after surgery on exact regime and time intervals of your recovery.
Table below provides rough guide as to the recovery intervals for some hand operations. More detailed schedule of recovery is shown under specific procedure in Hand and Wrist section.
|Splint duration (weeks)||Hand therapy duration (weeks)||Driving restriction (weeks)||Return to work (weeks)||Contact sports (weeks)|
|Dupuytren’s fasciectomy||4–12||2–4||usually 2||office – 1 manual – 4–6||6|
|Finger fracture||4||4–6||2||office – 2 manual – 6||8|
|Tendon surgery||6||6–8||4–6||office – 2 manual – 6–8||12|
|Joint replacement||6||8||3-4||office – 2 manual – 6–8||12|
|Finger fusion||6||2||2||office – 2 manual – 6–8||12|
|Wrist fracture||4-6||6||4||office – 2 manual – 6–8||8|
|Wrist arthroscopy||1||1-2||1||office – 1 manual – 2–3||3|
|TFCC repair||6||12||6||office – 2 manual – 6–8||12|
|Partial Wrist Fusion||4-6||8||4||office – 2 manual – 6–8||12|
|Proximal Row Carpectomy||3-4||6||4||office – 2 manual – 6–8||12|
|Total Wrist Fusion||5-6||4||6||office – 2–3 manual – 6–8||12|
As a Consultant who is involved with plastic surgery trauma on a daily basis, I am keen to help private patients with acute injuries too. This might not always be easy due to the busy schedules of patients, doctors and hospitals, but it is certainly worth giving us a call to check if you can be seen, assessed and reasurred about your diagnosis and plan of treatment. A competent opinion straight after injury might be as important as treatment itself. Majority of skin and hand injuries can be treated adequately and successfully 2-4 days after the accident allowing you time to make arrangements for your recovery, work and home cover after operation.
We will always do our best to accommodate you with an appointment at short notice, providing you have flexibility to attend one of my clinics. Please beware that in addition to urgent consultation, the anticipation and planning of possible surgery is necessary too. If we are unable to arrange ‘smooth’ care to include this, we will let you know and recommend another colleague who might be available and/or Accident and Emergency department.
Patients who are planning to self fund their treatment must ensure sufficient funds are available to support their intention. The costs in private healthcare quickly add up, so we try to keep the costs of your treatment to a minimum, offering competitive fees for services and avoiding all but essential additional interventions and investigations.
Whether or not you decide to undergo the recommended procedure, a consultation fee is charged for our initial meeting. A new consultation costs between £180-235 and follow up ones, unless included in you operation package, are between £90-140. Fee variations reflect variations in clinical complexity of cases. Simple interventions, like steroid injections which can be adminsitered in outpatients settings are charged separately, up to £115.
Prior to your operation, you are likely to be charged only for the initial consultation. Additional consultations are free and often welcome, especially for patients seeking cosmetic surgery, so please just let my secretary know if you have queries or concerns or would like to attend clinic and see me again prior to your surgery. The idea is that you should not have any doubts or unclear concerns ahead of agreed intervention. Let’s clarify them all beforehand.
In most hospitals, interventions, minor procedures and operations are charged in advance. We make all efforts to review packaged prices on a regular basis and keep them competitive. Hospital package prices include operation, anesthetic and hospital fees. My fees for surgery include postoperative follow-ups at more competitive price then if you were to pay them separately after the surgery.
The cost of patho-histological examination of tissue specimens is charged separately, usually between £180-220.
I am registered provider and fee assured with all major UK insurance companies. Charges for my services are reasonable and in line with accepted rates set by insurance companies.
If you have private healthcare insurance please make an effort to obtain a referral letter from your GP and authorisation code from your insurer before the consultation, if at all possible. This is not absolutely essential, but it streamlines the process significantly and helps you avoid the risk of being invoiced personally and/or encountering problems with your insurance company later. Please be aware that if your insurer refuses to pay for your treatment, you may become liable for the charges incurred. For urgent and acute referrals, ideally your insusrer should be informed in advance and you might need to insist on prompt administrative processing. We will do the best from our end.
The insurance company will be invoiced for the initial and follow-up consultations directly. Very often additional investigations and interventions (such as steroid injections) might be required in the clinic, so please check with your company the details of your policy. If you have no restrictions with your cover, it is unlikely that you will be involved in financial dealings between my billing company (Trust Health Limited) and your insurer at all.
If you require a minor procedure in outpatients settings, separate authorisation will be required in advance. We will instruct you on the exact codes for your procedure with enough time notice for your insurer whilst you are awaiting intervention.
Billing for the practice is handled by Trust Health Ltd, medical and billing solutions specialists. You or your insurance company will therefore receive invoices from them. In case of any queries do not hesitate to contact them via email email@example.com or phone 01403 241 484.
You can settle your invoice by one of the following methods:
Online by credit or debit card – visit www.trusthealth.co.uk
Credit or debit card via telephone – please call 01403 241484
BACS – Natwest, Sort Code 60 10 14, Account no: 87800802, please use invoice number as reference
Cheque – please send to Trust Health, Park House, North Street, Horsham, RH12 1RN quoting invoice number on reverse of cheque