What to expect after surgery
- After surgery, the child remains in an Intensive
Care Unit for 1-3 days, depending on the surgery.
- Swelling is most noticeable 2-3 days after
surgery and takes several weeks to completely
- In a patient with significant facial swelling,
the breathing tube is left in place to protect the
air passage. This remains until the swelling
improves and the patient can breathe on his or her
- The child will have drains in his head, this is
removed prior to the child being transferred out of
- The child normally enters high care for
monitoring purposes and then is put into a general
- Once the dressing/bandages are removed, the
scalp is able to be cleaned with a mild soap
removing all crusts.
- Dissolvable stitches are normally used, which do
not require removal.
- When the child is discharged, parents need to
watch for any redness or drainage around the suture
line, which may be a sign of infection.
Questions to ask the doctor
- How many Cranio Surgeries have they performed?
- What was the success rate?
- Can references be provided with contact details
of past patients?
- What is the preferred age for surgery?
- What will the approximate length of surgery be?
- Will the child need more than one operation?
- What will happened in the surgeon, please
provide details – this is so you have a better
understanding of the procedure
- What is the expected recovery time post surgery?
- What will the length of the hospital stay be,
inclusive of ICU?
- What will be used on your child’s head - staples
or absorbable stitches?
- How many units of blood will be needed for the
blood transfusion and will it be Adults Units?
- What type of incision will be made? (straight/zig-zag)
- Will they shave the childs head or not?
- What will the frequency of follow-up visits be?
- Does the doctor recommend that you go for
- What will the potential deformities, problems or
areas of concern be should you elect to not go
through with the surgery?
- What other specialists does the doctor recommend
that you consultant with (Ophthalmologists,
Pediatric Neurologist etc.)
- When is surgery set for?
- Will you be allowed to stay at the baby at
hospital and room in, will you have access to your
child 24 hours per day?
- Are you allowed to gain private donors for the
blood donation and what is the risk thereof?
- How long can my baby not eat or drink for prior
- How soon after surgery will I am able to see my
- What consent forms do I need to sign for surgery
and the hospital stay?
- Are they available to read in advance?
- If I am breastfeeding, will the hospital have a
breast pump available?
- Does the hospital have any policies regarding
nursing while in ICU?
- What do I need to watch out for following the
surgery? Any special precautions that I need to
- What should I bring to the hospital for my baby?
Items to take to the hospital
Infant / Child
- Favorite toy – bear in mind if the toy has
sound, you are normally in an open ward
- Front button vests or baby grows or t-shirts
depending on the age of the child
- The hospitals normally provide the bottles if a
- Formula/food (provided by hospital)
- Nappies and Toiletries are to be provided by
- Phone number list
- Cell Phone
- Tissues for tearful moments
- Comfortable clothes
- Snack food/gum
- Money for the coffee shops in the hospitals
Blood donation / Blood transfusions
Many families facing craniofacial surgery for their
children are forced to deal with and face a decision
with regard to the blood transfusion.
The South African National Blood Service as the
facility whereby you are able to elect and go with an
anonymous blood donor or you may request designated
(Directed) blood donations to be made by family members
or friendly that are a matching blood type for your
The South African Blood Bank follows safety
procedures to ensure the safety of anonymous blood:
blood donor eligibility standards, random screening and
laboratory testing, confidential exclusion of donations,
and donor record checks. Random checks are performed for
- Efforts are made to recruit safe and suitable
- Potential donors are asked a series of questions
about their health and lifestyle, including direct
questions about high-risk sexual behavior.
- The blood is tested for the possibility of
infectious diseases such as hepatitis, HIV, HTLV-I (
a virus associated with a rare form of leukemia),
HTLV-II, and syphilis.
- Potential donors are offered a confidential
opportunity to exclude their blood.
- Every donation is checked against existing
records. If a potential donor was rejected in the
past as indefinitely deferred, their blood will be
withdrawn from circulation.
The Process to follow should you wish to have
Designated (Directed) Blood Donation
- Your Doctor will provide you with the contact
details of the Blood Bank that is closest to you
- Your doctor will need to acknowledge your
request for a Designated (Directed) Blood Donation
and both the Pediatric Ward and the Doctor would
need to follow the Instruction of this from the
South African National Blood Service, which would
include the process to be followed for Ordering and
Handling of the blood.
- The Doctor will need to submit a letter stating
how many units are required for surgery
- A request will need to be done at a Laboratory
testing the blood Group of the patient, proof of
this is to be submitted to the Blood Bank
- The direct donors will then need to request a
Pathology report with a registered Laboratory: eg:
Ampath or Lancet detailing their Blood Group
- Proof and copy of this is to be given to the
- An appointment is to then be made with the Blood
Bank for the direct donors where a series of
confidential questions are asked. (Normally 5-7 Days
prior to surgery)
- The Direct Donors will then donate the unit of
- Testing will then be performed
- The Blood Bank will submit a copy of the
Barcodes that detail the Unit numbers of the direct
donors, this needs to be put in the Patient file
Note: You will be
required to sign an Indemnity stating that your doctor
has explained the risks of donated blood and the
possibility of transmission of infectious disease in the
The Process the hospital will follow
- Ensure the patient record has been clearly
marked that the patient has requested blood from a
directed donor. – The doctor will ensure that the
correct blood is administered
- A blood sample will be taken from the patient of
whom the hospital and doctors will co-ordinate this.
- Available units of designated (directed) units
will be cross matched and will be forwarded to the
hospital by the blood bank
Preparing older siblings for their younger
- Give explanations of the diagnosis and the
operative procedure in words that your child will
- Explain to the sibling that the doctors and the
operation will help their sibling get better.
- Tell your child when the operative procedure is
to take place and prepare them for the length of
stay in the hospital.
- Explain to their sibling that they will not be
allowed into ICU as they may carry germs that would
be bad for their sibling
- Explain that when the sibling enters high care
and the pediatric ward that should they be under the
age of 12 they will not be allowed in due to the
risk of infection
- Encourage your child to talk about the operation
and ask questions about the operation.
- Observe how your child plays, as this is how
he/she deals with thing that they do or do not
- Explain that their sibling will not be able to
feel, hear, or see anything during the operation as
the sibling will be given special sleep medicine to
make them sleep through the operation
- Do not make promises you may not be able to
- Ensure you advise them that the sibling will be
coming home with a big cut on their head and that
they need to be gentle as it is a big sore.
- In the week of the Surgery while you and your
spouse spend most of the time at the hospital,
ensure the sibling is in the care of trusted family
or friends where he/she will feel that they are
- Give attention and alone time to he other
sibling so they do not feel left out