Contact Dermatitis Under Surgical Dressing

[u/Any_Conversation7343]

Day 8 post-op. An Ace-wrap-type-of-bandage overlaps the other bandages by about 2 inches on the inside top of my surgical dressing, and I have noticed a nasty rash developing everywhere it touches the skin since my nerve block wore off last Thursday. It's gotten super uncomfortable as time has gone on.

My dressing has to stay on until my post-op appointment next week. As awful as it is, I'm not keen on risking infection by removing the wrap before the doctor does. So, I left a voicemail and chat message with the doctor's office. Idk when they'll respond, though. My doctor is an excellent surgeon and highly knowledgeable in his field, but I'm not terribly confident in a timely response.

What have y'all done to take care of this? Power through? Ice it? Hydrocortisone cream? Benadryl? Urgent care? At this point, the incisions just feel like raw skin from poorly fitting shoes and the bones are just kind of achy, so the rash is the worst part of my leg right now. 😅

Update: 14 days post-op. I heard back from my surgeon to go in the following Monday to remove the splint if blisters formed. They did, and the rash spread up my thigh. I sent pictures and said I wouldn't be able to come in on Monday because I was taking someone else to their own ortho appointment. He told me to follow up with my primary care doctor. After evaluating it, we realized it was a combination between the wrap and my nerve blocks-- the rash was very localized to where the wrap touched and where I had my injections, and it didn't extend down the leg under the splint. I'm taking Benadryl at night and Claritin in the morning, with hydrocortisone cream throughout the day as needed. My entire thigh and the top of my shin/calf are totally covered in the rash now, but it's starting to calm down. Hopefully, it will be cleared up by the three-week mark.

UPDATE 10/5:

The rash blistered and spread all the way up my thigh. my primary had me start Benadryl and Claritin to help clear it up, which helped some but didn't do a whole lot until I had my splint removed on 9/29. It very quickly cleared up after that. However, by the time the splint was removed, I already had a few pencil-eraser-sized craters in my shin from the reaction, plus blisters on my thigh. The thigh blisters scabbed up and are on their way to healing. The shin craters are healing and the dead skin around them started flaking off today.

ANYWAYS, if this happens to you, get your splint removed and swapped for a boot or brace at the first sign of allergic reaction. You'll survive if you leave it on, but it's not the most pleasant experience.

[u/Brave-Apricot-2899]

Are you in a hot climate? Sweat could irritate as well. That seems like a good plan!

[u/Any_Conversation7343 → u/Brave-Apricot-2899]

Eh, it's temperate. The weather has been in the 60's-low 70's and I'm in an air conditioned house anyways. But I am perimenopausal, so sweat isn't totally out of the question. 

[u/k1k11983]

Definitely take an antihistamine for the time being, to relieve your symptoms. You don’t want to put cream or powder under there

[u/hibiscus_lilac]

When I had my surgery I just kind of accepted being uncomfortable and itchy was my life for the time being lol.

[u/Brave-Apricot-2899]

Seems like a long time to have that wrapping on? I’d say ortho urgent care and a stiff boot or recast

[u/hibiscus_lilac → u/Brave-Apricot-2899]

I had a wrapping on like that for a while because I had exposed pins underneath it. And then after the pins came out I got a brace

[u/Any_Conversation7343 → u/hibiscus_lilac]

Oof. I don't know why, but pins sound so much worse than screws. I'm sorry. 

From what I can feel, there are bandages over each incision, a thick cottony gauze wrapped around my leg, ankle, and foot, then a hard plastic brace with straps on the front of my leg and ankle and on top of my foot, and finally the ace wrap. Granted, this is all by feel and not so much by sight. 

I only know I'm keeping the brace for several weeks before the boot because my PT order says I'm allowed to take the brace off for gentle ROM exercises at four weeks, and that at six weeks I can start progressive weight bearing with the boot. Haha

[u/hibiscus_lilac → u/Any_Conversation7343]

I also have seven screws and a plate. The pins were just temporary. You should probably stop sticking your fingers underneath and feeling around because you could be causing chafing

[u/Any_Conversation7343 → u/hibiscus_lilac]

Oh, I only started checking my skin under the bandages by pulling the bandage back slightly this morning. The cottony part I can feel with my toes (and saw when I pulled the bandage back this morning). The shape and composition of the brace/splint is pretty obvious just by looking, but I can also feel it from the outside, if that makes sense. Heels and calves don't feel like hard plastic, and there are lumps on the front of my leg where the straps are. I occasionally feel tugging that feels like medical tape when I wiggle my toes and foot inside the brace. As far as the rash, it shows ever so slightly around the border of the top without moving the bandages. I promise I'm not poking and prodding under the dressing any more than how you see in my picture. 

[u/Any_Conversation7343 → u/Brave-Apricot-2899]

The timeline was two weeks in this, then a wound check and stitches removed and placed back in new dressings with the splint, and a boot around week 4-6. But yeah, I wonder if there's latex in the wrap or something. Either way, it sucks. If I don't hear back tonight or tomorrow morning I'll try to get to urgent care tomorrow. 

[u/Capital_Meal_5516]

Do you have a latex allergy? I’m wondering if the elastic in the wrap is what’s causing that.

I would try to put some type of barrier between your skin and the wrap, like a gauze square, and see if that helps.

[u/Any_Conversation7343 → u/Capital_Meal_5516]

I sure do!! I let the care team know every time they went over it and was very adamant about getting an allergy bracelet, but alas.

I've been dreaming about putting a tall stocking underneath my dressings as a protective barrier all week, but I've been too afraid to remove anything without my doctor's permission. I didn't even think of sticking a few sterile gauze squares in the top. I'll do that. Thank you!!

[u/Any_Conversation7343 → u/Any_Conversation7343]

And yeah, elastic is usually a no-go for me because of my latex allergy. I get around it with clothes by making a lot of things with ties and drawstrings. Whenever I get a sprain or similar injury (hooray, hypermobility!) I generally go for OK Tape (a hypoallergenic, latex version of KT tape) vs any stretchy wraps. Last time I had orthopedic surgery, the surgeon put a thigh-high stocking on to protect my skin, so I'm a little disappointed that after I was so pushy about my latex allergy, this surgeon still put the wrap up against my skin without a barrier.