Addressing Practice Gaps in Cutaneous Surgery

Kreicher, Kathryn L.; Bordeaux, Jeremy S.

doi:10.1001/jamafacial.2016.1269

Cited by 18 publications

(18 citation statements)

References 73 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This is emphasized in the recently published cutaneous surgery guidelines. 21 Whereas diabetes has been associated with a higher rate of complications after free tissue transfer, prior work does not demonstrate an increased risk in Mohs reconstructive surgery of the face. 5,22,23 However, our study did not examine whether a patient's diabetes was controlled, so we cannot comment on uncontrolled diabetes as a potential risk factor for postoperative complications after MMS reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Association of Mohs Reconstructive Surgery Timing With Postoperative Complications

Miller

David

McLean

et al. 2018

JAMA Facial Plast Surg

View full text Add to dashboard Cite

IMPORTANCE Same-day Mohs reconstructive surgery is not always possible; moreover, a delay can offer benefits such as improved surgical planning and increased blood supply to the cauterized wound bed. However, recent work found that delaying reconstruction by more than 2 days increases the postoperative complication rate. OBJECTIVE To review the outcomes of Mohs micrographic surgery (MMS) reconstruction with respect to patient-and surgery-specific variables, especially timing of repair. DESIGN, SETTING, AND PARTICIPANTS Retrospective, single-institution cohort study of patients who underwent Mohs reconstructive surgery by 1 of the 2 senior authors from January 2012 to March 2017 for cutaneous squamous cell carcinoma or basal cell carcinoma. No patients had to be excluded for inadequate follow-up or incomplete medical records. MAIN OUTCOMES AND MEASURES Postoperative complications including hematoma, infection, dehiscence, and partial or full graft or flap loss. RESULTS A total of 633 defects in 591 patients (median [range] age, 65 [21-96] years; 333 [56.3%] female) were identified over the 5-year period. Reconstructions occurred from less than 24 hours to 32 days after MMS, with 229 (36.2%) delayed longer than 48 hours. Patient-specific variables reviewed included comorbidities, age, smoking status, and use of anticoagulant or antiplatelet medications. Surgery-specific variables analyzed included location and size of defect, time interval between MMS and reconstruction, and reconstructive modalities. Single-variable analysis was performed to determine whether each variable was associated with postoperative complications. On multivariable binary logistic regression, smoking status (odds ratio [OR], 2.46; 95% CI, 1.29-4.71; P = .007), defect size (OR exp(B), 1.04; 95% CI, 1.01-1.06; P = .006), full-thickness defects (OR, 1.56; 95% CI, 1.08-2.25; P = .02), interpolated flaps with cartilage grafting (OR, 8.09; 95% CI, 2.65-24.73; P < .001), and composite grafts (OR, 6.35; 95% CI, 2.25-17.92; P < .001) were associated with an increased risk of postoperative complications. CONCLUSIONS AND RELEVANCE We found no association between timing of Mohs reconstructive surgery and complications, indicating that a delayed repair did not increase the risk of infection or flap failure. Variables associated with an increased risk of postoperative complications include smoking status, size of the defect, full-thickness defects, interpolated flaps with cartilage grafting, and the use of composite grafts. LEVEL OF EVIDENCE 3.

show abstract

Section: Discussionmentioning

confidence: 99%

Association of Mohs Reconstructive Surgery Timing With Postoperative Complications

Miller

David

McLean

et al. 2018

JAMA Facial Plast Surg

View full text Add to dashboard Cite

show abstract

“…The group further recommended continuation of medically necessary anticoagulation and antiplatelet medications, and they recommended against use of topical antibiotic therapy. However, they did not look at whether oral antibiotics should be prescribed after MMS, and the last American Academy of Dermatology Position Statement on this issue remains vague as to who needs antibiotics after MMS 11 …”

Section: Discussionmentioning

confidence: 99%

“…The literature does not have specific data with regard to how often reconstructive surgeons, other than dermatologists, prescribe antibiotics after Mohs reconstruction. However, a recent article addressing the practice gaps in cutaneous surgery amongst the different specialties does not comment on oral antibiotic use; the authors do recommend against use of topical antibiotics 11 …”

Section: Introductionmentioning

confidence: 99%

“…However, a recent article addressing the practice gaps in cutaneous surgery amongst the different specialties does not comment on oral antibiotic use; the authors do recommend against use of topical antibiotics. 11 Multiple studies have demonstrated the very low incidence of postoperative surgical site infection (SSI) after MMS, even in the absence of prophylactic antibiotics. [12][13][14][15][16] We endeavored to study a large cohort of patients reconstructed after MMS of the head and neck to determine the rate of SSI in relation to factors such as prophylactic antibiotic use, defect size, and patient comorbidities such as smoking.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Do Postoperative Antibiotics Affect Outcomes in Mohs Reconstructive Surgery?

et al. 2020

View full text Add to dashboard Cite

Objectives/Hypothesis The prescribing of postoperative antibiotics for patients undergoing Mohs reconstructive surgery has increased in the last decade, while antibiotic resistance has been increasing. We hypothesized that routine prescribing of postoperative antibiotics after Mohs reconstruction does not decrease the risk of surgical site infection. Study Design Retrospective, single‐institution cohort study. Methods This study assessed patients who underwent Mohs reconstructive surgery from January 1, 2012, to January 29, 2019. The main outcomes assessed included postoperative surgical site infections, partial or full flap/graft necrosis, hematoma, and dehiscence. Results A total of 900 defects in 800 patients (mean age [range] = 65.3 [21–96], 54.60% female) were identified over the 7‐year period. Patient‐specific variables reviewed included comorbidities, age, and smoking status. Surgery‐specific variables analyzed included defect characteristics, time interval between Mohs micrographic surgery and reconstruction, reconstructive modalities, and use of postoperative antibiotics. All patients received peri‐incisional antibiotics. On regression analysis, use of cartilage grafts (odds ratio [OR]: 6.53; 95% CI: 2.1‐20.6; P = .001), current smoking status (OR: 6.67; 95% CI: 2.09‐21.30; P = .001), full‐thickness defects (OR: 1.2; 95% CI: 1.0‐3.4; P = .045), and interpolated flap reconstruction (OR: 3.4; 95% CI: 1.0‐11.5; P = .049) were associated with an increased risk of postoperative infections. Smoking and cartilage grafting remained significant on bivariable regression modeling. Use of perioperative antibiotics was not associated with a decreased risk of infection (OR: 1.82; 95% CI: 0.23‐14.21; P = .568). Conclusions We found no association between postoperative infections after Mohs reconstructive surgery and the use of postoperative antibiotics. These data support a more targeted approach to antibiotic prescribing in Mohs reconstructive surgery. Level of Evidence 4 Laryngoscope, 131:E434–E439, 2021

show abstract

“…Fatores relacionados com o doente e com o procedimento cirúrgico podem ser preditores da dor expectável e das necessidades analgésicas no pós-operatório. 32,44 Estes fatores encontram-se representados na Tabela 2.…”

Section: Identificação De Doentes De Alto Risco Para Dor Pós-operatóriaunclassified

Abordagem da Dor em Dermatologia (Parte I)

Duarte

Roberto

Cruz

et al. 2018

SPDV

View full text Add to dashboard Cite

RESUMO -A dor é um sintoma universal em Medicina e, na Dermatovenereologia, é transversal ao domínio médico e cirúrgico da especialidade. O controlo da dor aguda peri-operatória é um indicador de qualidade dos cuidados de saúde, sendo um fator determinante de morbilidade e de satisfação do doente. O tratamento pouco eficaz da dor crónica tem repercussões significativas na qualidade de vida e a nível socioeconómico. Esta revisão contempla os princípios gerais do tratamento da dor aguda peri-operatória e da dor crónica em Dermatovenereologia. Pretende-se sensibilizar para a importância da dor e contribuir para a redução da dor não controlada e a humanização dos cuidados prestados ao doente dermatológico. Nesta primeira parte da revisão, são abordados os aspetos epidemiológicos, a definição e o modelo conceptual atual para a compreensão da dor, bem como os fundamentos do tratamento da dor aguda peri-operatória. PALAVRAS-CHAVE -Dermatologia; Doenças da Pele; Dor; Medição da Dor; Procedimentos Cirúrgicos Dermatológicos; Tratamento da Dor. Pain Management in Dermatology (Part I) ABSTRACT -Pain is a major clinical symptom in medicine. In the scope of Dermatology, pain occurs most commonly in the surgical setting, but it is also associated with a wide spectrum of chronic medical entities. Control of acute perioperative

show abstract

Addressing Practice Gaps in Cutaneous Surgery

Cited by 18 publications

References 73 publications

Association of Mohs Reconstructive Surgery Timing With Postoperative Complications

Association of Mohs Reconstructive Surgery Timing With Postoperative Complications

Do Postoperative Antibiotics Affect Outcomes in Mohs Reconstructive Surgery?

Abordagem da Dor em Dermatologia (Parte I)

Contact Info

Product

Resources

About