Complications In Dermatologic Surgery Research Articles

Complications in dermatologic surgery: A case-control study exploring factors associated with postsurgical infection and wound dehiscence in a large national group practice

To the Editor: Dermatologic surgery is generally considered safe with estimated complication rates of <2%. 1 O'Neill J.L. Lee Y.S. Solomon J.A. et al. Quantifying and characterizing adverse events in dermatologic surgery. Dermatol Surg. 2013; 39: 872-878https://doi.org/10.1111/dsu.12165 Crossref PubMed Scopus (18) Google Scholar , 2 Strickler A.G. Shah P. Bajaj S. et al. Preventing and managing complications in dermatologic surgery: procedural and postsurgical concerns. J Am Acad Dermatol. 2021; 84: 895-903 Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar , 3 Cook J.L. Perone J.B. A prospective evaluation of the incidence of complications associated with mohs micrographic surgery. Arch Dermatol. 2003; 139: 143-152 Crossref PubMed Scopus (148) Google Scholar However, evaluation of the factors that contribute to complications gains merit in the context of the vast numbers of dermatologic procedures performed annually. This retrospective case-control study explores host and procedural variables associated with surgical wound dehiscence (SWD) and infection following dermatologic surgery, factors which are inadequately characterized or limited by small sample sizes in the current dermatology literature. 1 O'Neill J.L. Lee Y.S. Solomon J.A. et al. Quantifying and characterizing adverse events in dermatologic surgery. Dermatol Surg. 2013; 39: 872-878https://doi.org/10.1111/dsu.12165 Crossref PubMed Scopus (18) Google Scholar , 2 Strickler A.G. Shah P. Bajaj S. et al. Preventing and managing complications in dermatologic surgery: procedural and postsurgical concerns. J Am Acad Dermatol. 2021; 84: 895-903 Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar , 3 Cook J.L. Perone J.B. A prospective evaluation of the incidence of complications associated with mohs micrographic surgery. Arch Dermatol. 2003; 139: 143-152 Crossref PubMed Scopus (148) Google Scholar , 4 Delpachitra M. Heal C. Banks J. Charles D. Sriharan S. Buttner P. Risk factors for surgical site infection after minor dermatologic surgery. Adv Skin Wound Care. 2021; 34: 43-48 Crossref Scopus (3) Google Scholar , 5 Balakirski G. Kotliar K. Pauly K.J. et al. Surgical site infections after dermatologic surgery in immunocompromised patients: a single-center experience. Dermatol Surg. 2018; 44: 1525-1536 Crossref Scopus (17) Google Scholar

Translated article] Safety in Dermatologic Procedures: How to Prevent, Recognize, and Treat Bleeding Complications in Dermatologic Surgery

Bleeding complications during dermatologic surgery are uncommon and usually minor, but bleeding occasionally leads to infection, wound dehiscence, or flap/graft necrosis. This review covers the keys to preventing, recognizing, and treating excessive bleeding during and after surgery.

WITHDRAWN: Safety in Dermatologic Procedures: How to Prevent, Recognize, and Treat Bleeding Complications in Dermatologic Surgery

The Publisher regrets that this article is an accidental duplication of an article that has already been published, https://doi.org/10.1016/j.ad.2021.05.024 . The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal

Incidence of complications in dermatological surgery of melanoma and non-melanoma skin cancer in patients with multiple comorbidity and/or antiplatelet-anticoagulants. Five year experience in our Hospital.

Surgery is performed more frequently now at days, due to the increasing incidence of melanoma and no-melanoma skin cancer. There are different opinions among dermatologic surgeons between to continue or discontinue antithrombotic therapy prior to the procedure, which increases the risk of thromboembolic events. Prophylaxis with oral antibiotics in the postsurgical period is controversial. To report the safety of surgery without suspending antithrombotic therapy and without oral antibiotic prophylaxis in dermatology surgery of patients with multiple comorbidities and polypharmacy. We designed a retrospective study. We included a total of 655 patients; 96.6% had at least one comorbidity; 27.7% used aspirin and 4.3% some type of antithrombotic therapy. The most common type of skin tumor was basal cell carcinoma with 69.8% . The complication rate was 4.2%; the most was wound dehiscence (1.1%), followed by partial necrosis (0.9%), infection (0.9%), reaction to foreign body (0.6%), complete necrosis (0.3%), bleeding (0.2%) and fistulae (0.2%). Based on the literature and our experience, dermatologic surgery is safe without suspending antithrombotic therapy or antibiotic prophylaxis in patients with multiple comorbidity.

Incidence of complications in dermatological surgery of melanoma and non-melanoma skin cancer in patients with multiple comorbidity and/or antiplatelet-anticoagulants. Five year experience in our Hospital.

Surgery is performed more frequently now at days, due to the increasing incidence of melanoma and no-melanoma skin cancer. There are different opinions among dermatologic surgeons between to continue or discontinue antithrombotic therapy prior to the procedure, which increases the risk of thromboembolic events. Prophylaxis with oral antibiotics in the postsurgical period is controversial. To report the safety of surgery without suspending antithrombotic therapy and without oral antibiotic prophylaxis in dermatology surgery of patients with multiple comorbidities and polypharmacy. We designed a retrospective study. We included a total of 655 patients; 96.6% had at least one comorbidity; 27.7% used aspirin and 4.3% some type of antithrombotic therapy. The most common type of skin tumor was basal cell carcinoma with 69.8. The complication rate was 4.2%; the most was wound dehiscence (1.1%), followed by partial necrosis (0.9%), infection (0.9%), reaction to foreign body (0.6%), complete necrosis (0.3%), bleeding (0.2%) and fistulae (0.2%). Based on the literature and our experience, dermatologic surgery is safe without suspending antithrombotic therapy or antibiotic prophylaxis in patients with multiple comorbidity.

Mallet Finger as a Complication of Dermatologic Surgery

Mallet Finger as a Complication of Dermatologic Surgery

Factors that influence immediate complications in dermatologic surgery: A cohort study

Factors that influence immediate complications in dermatologic surgery: A cohort study

Basic Concepts in Skin Biopsy. Part I

The aim of these reviews is to describe the reasons for performing skin biopsy, to provide indications for the choice of area to be biopsied and the preparation of the sample, and to summarize the various complications of dermatologic surgery. In addition, we present a guide for selecting the biopsy technique based on the suspected diagnosis and on the area to be biopsied. Finally, the various artifacts that can complicate interpretation of results are described, together with the methods used to prevent their appearance insofar as is possible. The aim of this guide is to improve the diagnostic yield of biopsies and to highlight the importance of a correct clinical–histological correlation.

Hemorrhagic complications in dermatologic surgery

The ability to recognize, manage, and, most importantly, prevent hemorrhagic complications is critical to performing dermatologic procedures that have safe and high quality outcomes. This article reviews the preoperative, intraoperative, and postoperative factors and patient dynamics that are central to preventing such an adverse outcome. Specifically, the role that anticoagulants and anti-platelet agents, hypertension, and other medical conditions play in the development of postoperative hemorrhage are discussed. In addition, this article provides practical guidelines on managing bleeding during and after surgery.

La biopsia cutánea: bases fundamentales. Parte I

The aim of these reviews is to describe the reasons for performing skin biopsy, to provide indications for the choice of area to be biopsied and the preparation of the sample, and to summarize the various complications of dermatologic surgery. In addition, we present a guide for selecting the biopsy technique based on the suspected diagnosis and on the area to be biopsied. Finally, the various artifacts that can complicate interpretation of results are described, together with the methods used to prevent their appearance insofar as is possible. The aim of this guide is to improve the diagnostic yield of biopsies and to highlight the importance of a correct clinical-histological correlation.

Prospective evaluation of dermatologic surgery complications including patients on multiple antiplatelet and anticoagulant medications

Few prospective studies have evaluated the safety of dermatologic surgery. We sought to determine rates of bleeding, infection, flap and graft necrosis, and dehiscence in outpatient dermatologic surgery, and to examine their relationship to type of repair, anatomic location of repair, antibiotic use, antiplatelet use, or anticoagulant use. Patients presenting to University of Massachusetts Medical School Dermatology Clinic for surgery during a 15-month period were prospectively entered. Medications, procedures, and complications were recorded. Of the 1911 patients, 38% were on one anticoagulant or antiplatelet medication, and 8.0% were ontwo or more. Risk of hemorrhage was 0.89%. Complex repair (odds ratio [OR]= 5.80), graft repair (OR= 7.58), flap repair (OR= 11.93), and partial repair (OR= 43.13) were more likely to result in bleeding than intermediate repair. Patients on both clopidogrel and warfarin were 40 times more likely to have bleeding complications than all others (P= .03). Risk of infection was 1.3%, but was greater than 3% on the genitalia, scalp, back, and leg. Partial flap necrosis occurred in 1.7% of flaps, and partial graft necrosis occurred in 8.6% of grafts. Partial graft necrosis occurred in 20% of grafts on the scalp and 10% of grafts on the nose. All complications resolved without sequelae. The study was limited to one academic dermatology practice. The rate of complications in dermatologic surgery is low, even when multiple oral anticoagulant and antiplatelet medications are continued, and prophylactic antibiotics are not used. Closure type and use of warfarin or clopidogrel increase bleeding risk. However, these medications should be continued to avoid adverse thrombotic events.

Suporte básico de vida e suporte avançado de vida em cardiologia: proposta de uma nova estratégia para abordagem e prevenção das intercorrências clínicas em cirurgia dermatológica

Since complexity of surgical procedures has increased, and patients' co-morbidities have become more frequent, the risk of clinical complications in dermatologic surgery has also increased in the past decades. In order to better assess these risks, a flowchart based on a ruling triad consisting of the patient's health status, sedation level, and procedure complexity was developed to establish the type of cardiovascular support adequate to each procedure. Patients undergoing small surgeries with ASA < 2 should be assigned to basic life support; patients undergoing small surgeries with ASA > 2, and those undergoing medium-sized surgeries or deep sedation should be assigned to advanced cardiac life support (ACLS).

Complications in Dermatologic Surgery

Surgical complications are any deviation from the expected course of the surgical procedure. They occur as a consequence of one or more unexpected events, which can be avoided in the majority of cases through careful planning, a precise surgical technique, and correct postoperative care. Some complications, such as cardiac arrhythmias, anaphylaxis, and cardiorespiratory arrest, are life-threatening whereas others, occurring as a direct result of surgery, can affect the healing process and the final cosmetic appearance of the scar. We must therefore have not only the relevant training in dermatologic surgery, but also in basic and advanced cardiopulmonary resuscitation. In this review we discuss the perioperative measures necessary to avoid the onset of complications in dermatologic surgery and we define the various complications that can develop.

Complicaciones en Dermatología Quirúrgica

Surgical complications are any deviation from the expected course of the surgical procedure. They occur as a consequence of one or more unexpected events, which can be avoided in the majority of cases through careful planning, a precise surgical technique, and correct postoperative care. Some complications, such as cardiac arrhythmias, anaphylaxis, and cardiorespiratory arrest, are life-threatening whereas others, occurring as a direct result of surgery, can affect the healing process and the final cosmetic appearance of the scar. We must therefore have not only the relevant training in dermatologic surgery, but also in basic and advanced cardiopulmonary resuscitation. In this review we discuss the perioperative measures necessary to avoid the onset of complications in dermatologic surgery and we define the various complications that can develop.

Postoperative Topical Antimicrobial Use

Allergic contact dermatitis associated with topical antimicrobial agents is an increasing problem in the postoperative wound care period. We reviewed the topical antimicrobial agents most commonly used postoperatively in North America and Europe, examined the incidence of allergic contact dermatitis from each agent, and provided guidelines for the use of topical antimicrobials on closed and open wounds in the postoperative period. Neomycin was the most common cause of allergic contact dermatitis both in the general patch-tested population (11%) and in the postsurgical population. Bacitracin was also a common culprit, although at a lower rate (8%). There is a risk of co-reactivity between these two agents. Polymyxin B and mupirocin were not significant allergens. The rate of postoperative infectious complications in dermatologic surgery (1-2%) was similar to the rate of allergic contact dermatitis from topical antimicrobials (1.6-2.3%). We concluded that for closed wounds, the use of topical neomycin postoperatively should be avoided. White petrolatum is an efficacious and cost-effective alternative for closed wounds. For open wounds, topical antimicrobials that do not contain neomycin should be recommended.

Multiple antithrombotic agents increase the risk of postoperative hemorrhage in dermatologic surgery

Studies show that holding single antithrombotic agents perioperatively increases the risk of acute thrombotic events and does not significantly decrease the risk of bleeding complications in dermatological surgery. Recent data suggest that selected patients may benefit from combination therapy in preventing acute thrombotic events. We sought to evaluate postoperative bleeding complications in patients who underwent Mohs micrographic surgery while using multiple agents perioperatively compared with patients using a single agent or none at all. We conducted a retrospective chart review of patients treated in one academic Mohs micrographic surgery department during 1 year. Patients taking two or more agents at the time of surgery were more likely to bleed than those taking one agent or none at all (P = .0016, Fisher's exact). Small sample size and retrospective nature were limitations. Perioperative use of more than one antithrombotic agent increases postoperative bleeding risk.

Bleeding Complications in Dermatologic Surgery

Although the overall incidence is low, bleeding complications in dermatologic surgery can occur and be the source of significant patient morbidity. In this article, we summarize the key aspects of preoperative assessment of patients at risk for bleeding. A review of current issues and literature regarding safe continuation of anticoagulant and antiplatelet medications in dermatologic surgery patients is also presented. In addition, principles for management of bleeding events, should they occur, are also highlighted.

Intraoral Hematoma: A Novel Complication of Dermatologic Surgery

Intraoral Hematoma: A Novel Complication of Dermatologic Surgery

Bleeding Complications in Dermatologic Surgery

Although the overall incidence is low, bleeding complications in dermatologic surgery can occur and be the source of significant patient morbidity. In this article, we summarize the key aspects of preoperative assessment of patients at risk for bleeding. A review of current issues and literature regarding safe continuation of anticoagulant and antiplatelet medications in dermatologic surgery patients is also presented. In addition, principles for management of bleeding events, should they occur, are also highlighted.

Infection control practices and infectious complications in dermatological surgery

The aim of this study was to assess infection control practices and their impact upon infectious complications in skin surgery conducted by private dermatologists. A prospective study was carried out by 73 volunteers belonging to the Surgical Group of the Société Française de Dermatologie over a period of three months. Data were collected for surgical procedures performed during this period, including the excision of all benign or malignant tumours, but excluding sebaceous cysts and pyodermas. A total of 3491 dermatological surgical procedures were included in the survey. Post-operative infections occurred in 67 patients (1.9%), with superficial suppuration accounting for 92.5% of surgical site infections. The incidence was higher in the excision group with a reconstructive procedure (4.3%) than in excisions alone (1.6%). Infection control precautions varied according to the site of procedure; multivariate analysis showed that haemorrhagic complications were an independent factor for infection in both types of surgical procedure. The male gender, immunosuppressive therapy and not wearing sterile gloves were independent factors for infections occurring following excisions with reconstruction. Not all of the procedures needed the use of a hospital theatre. It is clear that for excisions with a reconstructive procedure or for certain anatomical sites, such as the nose, there should be more emphasis upon infection control precautions. Further studies are needed to establish optimal guidelines for this kind of surgery.