Clinical Characteristics of Lower Extremity Surgical Site Infections in Dermatologic Surgery Based Upon 24-Month Retrospective Review.

Dermatologic surgery performed on the lower extremities has an increased risk for surgical site infections (SSI). Our objective was to evaluate the clinical characteristics associated with SSI following Mohs micrographic surgery (MMS) and wide local excisions (WLE) performed below the knee. We performed a single-center retrospective chart review of patients (n=271) that underwent these procedures. Within 14 days of the lower extremity procedure, four of 175 MMS patients (2.3%) developed SSI compared to eight of 96 WLE patients (8.3%; P=0.029). Subcuticular sutures and vertical mattress sutures as a group were associated with reduced 30-day infection rate when compared to other suture methods (P=0.006). Comparison of patients on prophylactic antibiotics to control patients without antibiotics did not reveal a statistically significant difference in infection rate. MMS infection rates trended lower as compared to WLE in the 14-day post-operative window. Doxycycline prophylaxis did not produce a statistically significantly lower rate of SSI, though results approached significance. A prospective study may be warranted to further compare cephalexin and doxycycline for dermatologic surgery below the knee. Subcuticular or vertical mattress sutures may be preferred when closing wounds due to their association with reduced infection rate. J Drugs Dermatol. 2018;17(7):766-771.

A Retrospective Assessment of Postoperative Bleeding Complications in Anticoagulated Patients Following Mohs Micrographic Surgery.

BACKGROUND: A significant number of patients undergoing Mohs micrographic surgery (MMS) for skin cancer are treated with oral anticoagulants. The incidence of postoperative complications associated with new classes of oral anticoagulants remains largely unknown. OBJECTIVE: To determine the incidence of postoperative complications in patients undergoing MMS on both traditional oral anticoagulants and new novel oral anticoagulants. MATERIALS AND METHODS: A single-center retrospective chart review was performed for all patients treated with oral anticoagulants who underwent MMS between July 1, 2012 and June 30, 2015 at University of California, San Diego. RESULTS: The data from this study demonstrated that patients treated with a novel oral anticoagulant at the time of MMS had a statistically significant greater risk for developing postoperative hemorrhagic complications compared to patients treated with traditional oral anticoagulants. CONCLUSION: Dermatologic surgeons should manage both traditional oral anticoagulants and novel oral anticoagulants in a similar manner. Future studies are warranted.

Recurrence Rate of Melanoma in Situ when Treated with Serial Disk Staged Excision: A Case Series.

BACKGROUND: Cutaneous melanoma is one of the fastest rising cancer diagnoses in recent years. Melanoma in situ (MIS) constitutes a large proportion of all diagnosed melanomas. While surgical excision is considered the standard of therapy, the literature is not clear on which surgical technique minimizes local recurrence. A common technique is serial staged excision (SSE), in which a series of mapped excisions are made according to histopathological examination of tissue. Previously published recurrence rates for SSE ranges from 0-12%, over a range of 4.7-97 months of mean follow-up. OBJECTIVE: To investigate the recurrence rate of MIS when excised using a serial disk staged excision technique with tissue marked at 12 O'clock for mapping, rush permanent processing and histologic examination, 3-suture tagging for subsequent stages, and "breadloafing" microscopic analysis. Additionally, to determine the relationship between initial lesion size and subsequent stages of excision required for clearance, and final surgical margin. METHODS: Single-institution retrospective chart review of 29 biopsy confirmed MIS lesions treated with our variant of SSE. Statistical analysis via independent t-tests. RESULTS: No recurrences were observed with mean follow-up of 31.5 months (SD 13.9), over range of 12-58 months. Mean surgical margin of 13.1 mm (SD 5.9). A trend towards larger surgical margin was seen with increasing pre-operative lesion size. CONCLUSION: This method of SSE for treatment of MIS is comparable in efficacy to other SSE techniques, and may offer physicians a relatively simple, efficacious, and accessible alternative to wide local excision and Mohs micrographic surgery.

A Combination Approach to Surgical Scars.

BACKGROUND: Scar formation from surgical procedures is an unavoidable risk. Despite measures taken by both the surgeon and patient during the perioperative and postoperative periods to maximize cosmesis, some patients will wish to pursue surgical or laser scar revision. OBJECTIVE: The authors propose a treatment algorithm to assist in approaching surgical scar revision with combination treatments. MATERIALS AND METHODS: A PubMed search was performed on various surgical scar revision techniques. The authors augment these findings with their own personal experiences. RESULTS: Reports of surgical excision, intralesional corticosteroid injection, intralesional 5-fluorouracil injection, pulse dye laser treatment, nonablative fractional laser resurfacing, ablative fractional laser resurfacing, and microneedling and fractional needle radiofrequency, used in isolation or combination, were found. The authors also provide clinical photographs documenting improvement in appearance of surgical scars using these treatments. CONCLUSION: Surgical scars are best treated with a combination approach to address various features of the scar. The authors propose a treatment algorithm with multiple treatment options and how to combine them safely and effectively.