Update and Review of Bleeding Considerations in Dermatologic Surgery: Hemostatic Techniques and Treatment Strategies for Bleeding Complications

Abstract

BACKGROUND There are many intraoperative and postoperative techniques to aid hemostasis in dermatologic procedures. An updated understanding is critical for the surgeon. OBJECTIVE To provide an updated review of methods for hemostasis and therapies for postprocedural purpura and ecchymosis applicable to dermatology. MATERIALS AND METHODS A review of Ovid MEDLINE was performed to review the English-language medical literature of hemostatic options and their use in cutaneous surgery. All available publication years were included from 1946 to present. RESULTS A comprehensive and current list of hemostatic options used in the intraoperative and postoperative period is provided along with traditional and emerging therapies for postprocedural purpura and ecchymosis. CONCLUSION A myriad of options exist for minimizing and treating bleeding complications. The appropriate use and updated knowledge of hemostatic options is provided.

Complications of cutaneous surgery

“…Investigations of the novel oral anticoagulant agents (NOACs) including dabigatran, apixaban, and rivaroxaban have also demonstrated low hemorrhagic complication rates similar to those of traditional oral agents, and no severe or life‐threatening hemorrhagic complications 21,29,30 . At the current time, guidelines suggest continuing NOAC agents for dermatologic surgery 31,32 . Further, stopping medically necessary antithrombotic agents during cutaneous surgery has been associated with severe thrombotic complications such as stroke, myocardial infarction, deep venous thromboses, pulmonary embolism, and death; it has also been proposed that stopping these agents may not reduce the risk of bleeding 23,25 …”

“Balloon Glove” Technique: An Easy Alternative to Pressure Dressing for Postoperative Hemostasis

“…In routine postoperative care, pressure dressings are used to protect the wound, prevent bleeding, and decrease the risk of hematoma formation by compressing dead space. 1,2 However, in certain anatomic areas, the application of a standard pressure dressing composed of gauze and tape may not be feasible. Hair bearing and intertriginous sites in particular can hinder dressing placement because of inability to secure adhesive tape or an elastic bandage wrap, and dressing removal in these areas may cause patient discomfort and skin trauma.…”

“…Various strategies exist to promote hemostasis and minimize bleeding complications after dermatologic procedures. 1,2 The choice of hemostatic method depends on the type of surgery, anatomic location, patient characteristics, maintenance requirements, and cost. Here, we present a novel technique that repurposes a medical examination glove to act as an effective pressure dressing on surgical wounds.…”