Prospective Study of Wound Infections in Dermatologic Surgery in the Absence of Prophylactic Antibiotics

Abstract

Based on a prediction of infection incidence over 5%, the following cutaneous oncologic procedures warrant consideration of oral antibiotic wound infection prophylaxis: all procedures below the knee, wedge excisions of lip and ear, all skin grafts, and lesions in the groin. Other than under these circumstances, surgery to the nose, ear, fingers, lips, skin flap surgery, and surgery on diabetics, smokers, and those on anticoagulants have previously been considered for wound infection prophylaxis but do not warrant such intervention based on our data. The authors have indicated no significant interest with commercial supporters.

Prospective Study of Skin Surgery in Patients With and Without Known Diabetes

“…Details have been previously described. 11 The attending dermatologic surgeon followed up wounds clinically until wound healing was complete, at least until removal of sutures and longer if there was skin flap or graft surgery involved or if a complication was experienced.…”

“…1,4 Patients with diabetes are said to be at greater risk of wound infection, [4][5][6][7][8][9] although some studies have suggested otherwise. [10][11][12] Some suggest that noninfective skin complications such as dehiscence, wound slough, necrosis, greater reoperation requirements, and slower healing may be more prevalent in people with diabetes, 6,[13][14][15] whereas others do not. 16 Surgeons frequently alter their antibiotic management if their patients have diabetes.…”

“…3 We have previously investigated postoperative wound infections and reported in this journal. 11 That study examined wound infections and their risk factors. Our data suggested that patients with diabetes were not at greater risk, but that analysis was univariate and did not consider that people with diabetes might differ in sex, age, or other bias from those without.…”

Infection Rates of Wound Repairs During Mohs Micrographic Surgery Using Sterile Versus Nonsterile Gloves: A Prospective Randomized Pilot Study

“…There may be even less inherent infection risk with simple excisions because the closure is performed immediately after tumor removal, and the closure type used is often associated with a lower rate of morbidity. 7 In looking at the financial aspect of our study, the two Mohs surgeons and two fellows perform roughly between 1,500 and 2,000 Mohs cases per year. With an average of two pairs of gloves used during an average Mohs repair, the cost savings is $11.72 per pair of clean, nonsterile gloves used instead of sterile gloves ($6.25 per pair of sterile gloves vs $0.39 per pair of clean, nonsterile gloves).…”

Mohs Surgeons' Use of Topical Emollients in Postoperative Wound Care

“…The risk for infection after dermatologic surgery is low (1-2.3%). [2][3][4] Recent studies, including a pivotal randomized, double-blind, prospective trial, have shown that the application of topical white petrolatum for clean postoperative wounds yields a rate of infection similar to that of topical bacitracin while having a lower risk of allergic contact dermatitis. 5 Another randomized controlled trial using mupirocin, which rarely causes allergic contact dermatitis, demonstrated no benefit in terms of infection rates or healing of clean surgical wounds.…”