You'll find hundreds of files on cleft lip, cleft palate here on

This one is about: Red Flags of Infection (Complications After Surgery)

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A Parent's perspective on warning signs of post-operative infection

by Leigh Austin

(Note: The purpose of this article is not to scare anyone, but rather, to let parents know that infection is possible, and to prepare them in the event that it does happen.)

Ok, so infection to a surgical site is rare. Just like anything else, there is bound to be someone, somewhere, who can attest that it happened to them. I am that someone in this instance, or rather, my son, is.

My son, Bryan, who was born 12/30/95 with a complete bilateral cleft lip and palate, suffered a life-threatening infection to his lip repair in June of 1996. My husband and I were far from prepared, nor did we even know what to look for. Needless it say, it was three days before we knew for sure that there was something very wrong. By that time, Bryan's eyes were swollen shut, and his face was the worst shade of black and blue you have ever seen. His fever was 106 degrees, and his nose drained pus at the slightest touch.

Looking back on it now, it seems like it happened so fast - almost overnight. But in reality, we could have seen the signs coming, if we had known what to look for.

This was our first surgery, and our worst surgery. Although we had read every book, spoken to other parents, nurses, and doctors, we were not prepared for what happened to us. No one warned me that there was a possibility that my son could get an infection. I mean, who thinks about that?

Surgeons and operating rooms are supposed to be the most sterile of headquarters, right? Not always. Occasionally someone can get careless and transport bacteria into the room. Hospitals carry lots of bacteria and they grow their own too - in the labs. Our son was infected during surgery with several different strains of bacteria known to be grown in hospital laboratories. Besides the extensive internal tissue work done to repair his very wide bilateral cleft, there was already trauma in the surgical site, and the bacteria found a very suitable place to grow.

My son's attitude was typical of a child who had just had surgery. I couldn't tell that there was anything else going on right away. He tried to smile, and tried to laugh the best he could. He ate and played with toys. Someone told me that before the swelling, bruising, and bleeding got better, they would get worse, so who could tell if there was an infection going on? Well, you can. Here are some symptoms and experiences to help you.

Because there is so much happening to your child following surgery, sometimes it is difficult to discern what should and should not be going on. Please use this list as a guide of red flag warnings to look for. Remember that a post surgical infection will manifest itself within the first three days following surgery, if not sooner.

FEVER: Doctors say that following surgery, your child may sometimes run a temperature as the body heals itself. But fever is also the best indicator that there is an infection going on. Monitor your child's temperature very closely. If your child runs any temperature at all over 100 degrees for any length of time, check with your doctor. Our son ran high temperatures frequently when he was sick, so when he had a temperature of 101 degrees to 102 degrees, we didn't run for the phone. But as it escalated, we knew something was going on.

CHANGES IN ATTITUDE. Although Bryan didn't change his attitude until the third day following surgery, many children do. If you know your child gets lethargic when he has a fever, or screams when he has an earache, and he exhibits that behavior, that could be a good indication that there is something else going on besides his lip pain.

EXCESSIVE SWELLING. You can expect that your child will be swollen following surgery, especially around the mouth. But if your child's swelling extends beyond that area, or if the surgical site looks excessively swollen, call your surgeon. There is a danger that too much swelling can and will pop stitches out, and/or ruin your whole repair. Thank goodness we were able to catch Bryan's in time, but he did lose several stitches.

EXCESSIVE BRUISING. Sometimes (as in our case) with larger clefts there is extensive internal tissue work to be done in the surgery. Muscles are sometimes pulled closer together. This tissue work can cause a lot of internal bleeding, and/or hemorrhaging or hematomas. While a hematoma by itself is not necessarily bad, it is extremely conducive to growing an instant infection. We noticed right away in the recovery room that our son's face was far too bruised, and we asked why. Of course, no one told us that he had a hematoma until after he was diagnosed with the infections. Remember, it never hurts to ask. If your child looks like he was beaten up, ask why. Don't assume that he/she is supposed to look like that.

HEAT. If your child's surgical site is hot to the touch of your hand, that may be an indication that there is something going on. Bryan's surgical site became hot the day after surgery. While it may not be necessary to phone your surgeon for this alone, if your child has any of the other symptoms as well, call.

REDNESS. You can expect that the surgical site will have some redness to it as it heals. But if the site is red and hot, don't walk, run to the phone. Bryan's face was a rainbow of colors, beginning with red. The redness came 24 hours after surgery.

PUS. Obviously, if there is pus, there has been an infection for some time. Bryan had pus two days post-op.

One thing to remember also, is that in the hospital, there are many strains of bacteria floating around. Nurses and doctors come into contact with everything under the sun -- that is why it is critical that they scrub before surgery. It is also critically important to make sure that they wash their hands before they touch your child or you. I am convinced that one of the hospital staff was careless about washing up when they went into the operating room with my son, and that is how he became infected during surgery. It is absolutely your right to make sure that the doctor, nurse, technician or any medical personnel you are in contact with follows these very common safety practices -- whether giving you a simple examination or going into surgery with you.

Always keep in mind that it is better to ask your doctor or surgeon about what is going on than to wait until it becomes worse. I wish I had never brought my son home from the hospital following his lip repair. I knew that there was excessive swelling and bruising - I had asked about it. He had a temperature when we left the hospital but was eating, and he seemed happy enough, so they let us go. Those are the requirements for going home.

Three days later, as I sat in our pediatrician's office rocking my virtually lifeless son in my arms, I wished that I had paid attention to my concerns. But you try not to think of the worst - even when you're being paranoid. It may be in the back of your mind, but usually so rare an occurrence, that you brush it aside.

What I am saying is, if you feel that something is wrong, ask, call or go back to the hospital. It is better to be safe that sorry, right?

Infection can definitely be treated successfully with antibiotics. And of course it is extremely rare. There is no reason to panic if your child exhibits the symptoms. Remaining calm, writing down the temperature, administering Motrin or Tylenol if appropriate, and comforting your child are the most important things for you to do as you contact your doctor and/or take your baby to the hospital.

Here it is, seven months later, and Bryan is no worse for wear. His repair is beautiful, even though we lost a few stitches. He won't remember anything about the surgery or the infection, but we learned a great deal from it. Mostly we learned how much we loved our beautiful little baby, cleft and all.

-----------------------Leigh Austin lives in Castro Valley, California.

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