Evaluating complications in below‐knee skin cancer surgery after introduction of preoperative appointments: A 2‐year retrospective cohort study

Abstract

Below‐knee dermatological surgery has a high risk of complications such as wound infection, bleeding, and necrosis. In this study, we evaluated the impact of preoperative appointments on complication risks. We searched the medical records of the Helsinki University Central Hospital (HUS) Dermatosurgery unit for all below‐knee surgeries during 2016, when no preoperative nurse appointments were carried out, and compared it with 2018, when preoperative appointments for risk patients were introduced. The study included 187 patients in 2016 and 179 patients in 2018, of whom 68 (about one third) attended preoperative appointments. At the appointments, risk factors were evaluated, and compression therapy was introduced when possible. The results show complication rates of 13.4% in 2016 vs 10.1% in 2018 (P = .33), despite significantly higher risks in the 2018 patient group. The odds ratio for complications in appointment attendees vs non‐attendees was reduced after adjustments to 0.58; however, this was insignificant (P = .47). The odds of complications for skin grafts were considerably higher: 11.33 vs other surgery techniques (P = .00). In conclusion, the introduction of preoperative appointments appeared to reduce complications in below‐knee surgery. For graft reconstructions, complication risk is high, even with carefully planned pre‐ and postoperative care. Further studies are needed to evaluate preventable risk factors of below‐knee graft reconstructions.

An exploratory randomized clinical trial on negative pressure wound therapy for lower limb full‐thickness skin grafts of dermatosurgical patients

“…3 Full-thickness skin graft (FTSG) reconstructions of the lower leg are safe 4 and achieve a good cosmesis, 5 however, they can require numerous postoperative visits, 6 and are particularly at risk for wound complications, such as bleeding, infection, delayed wound healing, or necrosis. 7 In our previous retrospective study 34-43% of FTSGs resulted in a complication, and we concluded an 11 times higher complication risk for these interventions compared with primary closed wounds. 7 Negative pressure wound therapy (NPWT) is a successful treatment, e.g., for chronic wounds, 8,9 for primary complication prevention of primarily closed surgical wounds, 10,11 for wounds left for secondary intention healing (SIH), 9 and it reduces surgical site infections in splitthickness skin grafts (STSGs).…”

“…7 In our previous retrospective study 34-43% of FTSGs resulted in a complication, and we concluded an 11 times higher complication risk for these interventions compared with primary closed wounds. 7 Negative pressure wound therapy (NPWT) is a successful treatment, e.g., for chronic wounds, 8,9 for primary complication prevention of primarily closed surgical wounds, 10,11 for wounds left for secondary intention healing (SIH), 9 and it reduces surgical site infections in splitthickness skin grafts (STSGs). 12,13 A consensus recommendation advises NPWT to be used with a continuous pressure for 3-7 days on STSGs.…”

“… 7 In our previous retrospective study 34–43% of FTSGs resulted in a complication, and we concluded an 11 times higher complication risk for these interventions compared with primary closed wounds. 7 …”

“…24 It has been shown, that especially elderly patients, and those with flap or graft reconstructions, benefit from preoperative appointments; where compression therapy is initiated, and other possible risk factors reduced. 7 Of our patients, 13 attended a preoperative appointment (seven of the NPWT group, six of the control group). When considering our results, the at-risk patients, i.e., patients using mobility aid, with high age, with peripheral vascular disease, or with ulcerated, infected, or inflamed skin tumour might benefit from additional risk-reducing measures, such as prophylactic antibiotics, nutritional status assessment, postoperative ward care, and more effective and longstanding postoperative compression treatment.…”

Does the use of compression bandaging as an adjunct improve outcomes for people following excision of keratinocyte cancers of the lower leg with secondary intention healing?

“…The second study, by Lindholm et al ., 4 found that of 366 patients, those with postoperative compression were less likely to develop complications compared with those who had no compression (OR = 0.67); however, this was not statistically significant ( P = 0.74). Observed complication rates were 12.2 times higher with full thickness skin graft (FTSG) below the knee compared with other surgical techniques (including secondary intention healing).…”