Abstract

Performed in an outpatient, office-based setting, dermatologic surgery reduces healthcare costs of hospitalization while maintaining low rates of surgical complications such as infection, dehiscence, and hematoma formation. However, the potential for complications requiring hospitalization or IV antibiotic therapy still exists and varies depending on patient risk factors, such as the use of antiplatelet and anticoagulant medications. Furthermore, measured outcomes in dermatologic surgery expand beyond surgical wound complications to include optimization of wound healing and reduction of scar formation, especially in cosmetically sensitive areas of the body. Biosurgical agents are increasingly being used in surgical fields to achieve hemostasis and to optimize wound healing. This chapter reviews the typical methods to achieve hemostasis in dermatologic surgery and examines the current and future role of biosurgical agents in procedural dermatology.

Highlights

  • Dermatologic surgery includes office-based procedures such as skin biopsies, excision, desiccation and curettage, and Mohs micrographic surgery [1]

  • We provide an overview of the methods to achieve hemostasis and of the use of biosurgical agents in dermatologic surgery

  • This method is usually used in patients with implanted cardiac defibrillators (IDC) due to no current delivered to the patient [3]

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Summary

Introduction

Dermatologic surgery includes office-based procedures such as skin biopsies, excision, desiccation and curettage, and Mohs micrographic surgery [1]. Factors that influence the choice of hemostatic agent include location, wound size, and amount of bleeding [2]. Other factors that influence hemostasis include the patient’s medical history, medications, and the inherent qualities of the skin at the site of the surgery. The use of antiplatelet or anticoagulant medications may decrease the efficacy of some hemostatic agents. Concurrent medical disease such as liver cirrhosis can lead to alterations in platelets and the coagulation pathways. Many methods exist to achieve hemostasis intra- and post-operatively. These include topical hemostatic agents, adhesives, electrosurgery, sutures, and biologic agents. We provide an overview of the methods to achieve hemostasis and of the use of biosurgical agents in dermatologic surgery. Contemporary Applications of Biologic Hemostatic Agents Across Surgical Specialties Volume 2

Physiologic hemostasis
Mechanical agents
Physiologic agents
Biologic agents
Chemical agents
Physical agents
Synthetic, mechanical adhesives
Hemostatic dressings
Electrosurgery
Sutures
Biosurgical agents in wound care
Dressings
Grafts
Conclusions
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