What to Expect in Your Patient Journey

Avanthi offers private consults at Heidelberg and Wantirna. She aims to provide local operating and consulting for patient convenience. She operates at Glenferrie Private Hospital in Hawthorn, Warringal Private Hospital in Heidelberg and Knox Private hospital in Wantirna. She has public hospital appointments at Austin Health and Monash Health, Dandenong Hospital where uninsured patients requiring surgery can be referred.

Avanthi is happy to accept all patients wanting a private opinion regarding their Hand, Wrist, Elbow or Shoulder problem. Uninsured, work cover, TAC and ADF patients are welcome.

Initial consultation fees are charged at $220 and subsequent consultations at $110 with portion covered by the medicare rebate. Discounted rates are available for health care card holders and pensioners. An out of pocket gap fee is charged for surgical procedures and fees will be discussed by an informed financial consent process specific to your condition, which includes item numbers, a verbal discussion and written quote prior to surgery. Surgical fees cover the cost of surgery and in most cases 6 weeks of follow up and nursing aftercare.

Additional fees that may be incurred in addition to Avanthi’s fees may include that of the anaesthetist, surgical assistant and hospital excess fees. Informed financial consent can be provided by these providers directly; their contact details can be found here.

Medical Imaging – For Avanthi to provide you with the most time efficient and informative consultation, please bring with you any previous medical imaging (printed films or CD) and reports and any other test results. If you have had a previous operation for which an opinion is required, please obtain a copy of any operation reports or correspondence from your treating practitioner.

Splints – If you have been provided with any splints, slings or braces, please bring these with you to your appointment.

Support person – We welcome you to bring a key family member or support person to help you explain your problem and recall any information provided. 

Avanthi is committed to advancing hand and upper limb surgery techniques and improving educational content for patients and doctors. Any new implants or emerging technologies will be transparently discussed with patients to allow you to make an informed choice about your treatment. Monitoring surgical outcomes is a key component of advancing the field of surgery and you may be asked to complete pre-and post-operative questionnaires used for the purposes of research and peer review publication. Consent may be requested to take photographs before, during and after surgery for educational purposes. Consent can be withdrawn at any stage.

Swelling

  • Swelling in your wrist and fingers is common following surgery.
  • Early finger movement and elevation of your hand, above the level of your heart, on a few pillows will help reduce swelling
  • Ice packs or ice in a bag covered with a clean dish cloth, to the operative area over the first 24-48hrs can help reduce swelling

 

Pain management

 You will have some pain following surgery but we prioritise your pain control as an important part of your recovery process. 

  • You may have had a local anaesthetic block to the arm or local anaesthetic administered around the wound prior to you leaving the operating theatre.  This can leave the fingers and wound numb whilst it is still in effect. This can last from 6-24hrs
  • You may experience tingling in your fingers as the local anaesthetic or block starts to wear off which is a sign to take some extra painkillers.
  • You should take some simple painkillers, paracetamol and an anti-inflammatory (if you have are able to take them) to take strictly for the first 72 hrs. After this time, you may reduce the frequency of these painkillers and can be taken as and when required.
  • You may also be prescribed a stronger painkiller (a narcotic or morphine like medication) to be started in the first 6 hours following surgery. This can be a long acting painkiller to be taken twice a day for the first 72 hrs. 
  • You may also be prescribed a short acting narcotic/morphine-like painkiller if you are experiencing strong pain that is not controlled with your regular painkillers. You should take one tablet when your local anaesthetic starts to wear off.
  • If you are on pre-existing pain medications, you should take your regular dose of medications and will likely need to have these medications in addition.  This will be discussed with you prior to being discharged.
  • After hand surgery, I recommend taking 1 tablet daily, of Vitamin C 500mg for 6 weeks, which can be sourced from your local pharmacy following your surgery, to decrease your risk of chronic pain and swelling.
  • If you have had elbow surgery, you may also be required to take Indomethacin (an anti-inflammatory) specifically to reduce your risk of developing stiffness and excessive bone formation in the joint. You should take this for 3 months unless otherwise stated. This is not for the painkiller effect of Indomethacin.

 

Wound management 

  • Your wound may be closed with a dissolvable stitch which will need to be trimmed flush with the skin at review appointment.
  • You may have steri strips to cover your wound and a waterproof dressing. Leave this dressing intact unless there is a considerable amount of blood or ooze, in which case the GP, or nurse at your local practice can change the dressing.
  • A layered compression bandage will be applied to help minimise swelling and further bleeding. You will be advised if you should remove these dressings prior to your post-operative appointment in which case the outer bandages can be removed after 48-72 hours following surgery. Otherwise, leave the dressings intact until your review appointment.

 

Restrictions following surgery

Showering – Whilst you have the compression bandages in place, keep the dressings dry with a plastic bag and rubber band when showering.  After the bandage has been removed, you can get your waterproof dressing wet ensuring that the water is not too hot to cause sweating of the skin that can lift off the dressing.  Pat the dressing dry.

Do not immerse the wound in water ie pool or bath tub, until 2 weeks or until the wound has healed.

 

Lifting/Weight bearing 

You will be advised as to whether you can lift or put weight through your arm. Restrictions may include:

  • Non – weight-bearing – No lifting, firm gripping or pushing through your hand/wrist for 6 weeks or until review
 
  • Partial weight-bearing – Limited lifting, pushing to a weight of 300g (can of soft drink)
 
  • Weight-bear as tolerated – No restrictions 
 

Movement – Small movements within the bandages or splint is acceptable. You will be provided with a sling if it is deemed necessary.

Driving – There are no firm guidelines to assist in return to driving following surgery. You require the use of both arms to safely operate an unmodified vehicle. You are strongly advised not to drive whilst you are immobilised in any form of cast, splint or bulky bandage as this may affect you safety and the validity of your car insurance policy. You are also advised not to drive if you are taking strong painkillers which can cause drowsiness. After this time, the ability to drive is based on your ability to safely manoeuvre your vehicle out of dangerous situations to protect yourself and others. This will depend on your level of pain, range of movement around the hand and wrist and grip strength and is ultimately your responsibility. If in doubt, await follow up review before returning to driving.

 

Rehabilitation/Physiotherapy 

In most cases, following surgery you will require some form of physiotherapy or hand therapy for management of the following aspects:

  • Swelling control
  • Scar management
  • Reducing stiffness and regaining motion
  • Improving strength
  • Custom splint (if required)
 

Concerns or emergencies

If you have any concerns regarding your recovery, please feel free to email or contact me through my staff during business hours, or me directly on 0487208655 if you have an urgent problem out of usual business hours.  In the event of an emergency, please do not delay in seeking urgent medical attention through your closest hospital Emergency Department if you are unable to contact your local doctor or myself.

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Dr Avanthi Mandaleson

Specialist Hand & Upper Limb Surgeon​
(BMedSci, MBBS, FRACS, FAOrthA)

For all appointments please call (03) 9456 9077