RESUMO
BACKGROUND: Ulceration is a recognized risk factor for surgical site infection (SSI); however, the proportion of patients developing SSI after excision of an ulcerated skin cancer is unknown. AIM: To determine the proportion of participants with SSI after surgical excision of an ulcerated skin cancer. A secondary aim was to assess feasibility outcomes to inform the design of a randomized controlled trial to investigate the benefits and harms of perioperative antibiotics following excision of ulcerated tumours. METHODS: This was a multicentre, prospective, observational study of patients undergoing excision of an ulcerated skin cancer between March 2019 and March 2020. Prior to surgical excision, surface swabs of the ulcerated tumours of participants recruited from one centre were undertaken to determine organism growth. At 4 weeks after surgery, all participants were e-mailed or posted the Wound Healing Questionnaire (WHQ) to determine whether they had developed SSI. RESULTS: In total, 148 participants were recruited 105 (70.9%) males; mean ± SD age 77.1 ± 12.3 years. Primary outcome data were available for 116 (78.4%) participants, of whom 35 (30.2%) were identified as having an SSI using the WHQ with a cutoff score of 8, and 47 (40.5%) were identified with a cutoff score of 6. Using the modified WHQ in participants with wounds left to heal by secondary intention, 33 (28.4%) and 43 (37.1%) were identified to have SSI respectively. CONCLUSION: This prospective evaluation of SSI identified with the WHQ following excision of ulcerated skin cancers demonstrated a high proportion with SSI. The WHQ was acceptable to patients; however, further evaluation is required to ensure validity in assessing skin wounds.
Assuntos
Neoplasias Cutâneas , Infecção da Ferida Cirúrgica , Idoso , Idoso de 80 Anos ou mais , Antibacterianos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Cutâneas/cirurgia , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia , CicatrizaçãoAssuntos
Vacinas contra COVID-19/efeitos adversos , COVID-19/prevenção & controle , Toxidermias/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Vacina BNT162/efeitos adversos , ChAdOx1 nCoV-19/efeitos adversos , Toxidermias/tratamento farmacológico , Toxidermias/patologia , Toxidermias/fisiopatologia , Feminino , Glucocorticoides/uso terapêutico , Antagonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Fenótipo , SARS-CoV-2 , Adulto JovemRESUMO
This is the second part of a two-part series summarizing the latest evidence related to suture materials and wound closure techniques in dermatological surgery. We critically appraised evidence focusing on the following consequences of suture choice: scar/cosmesis, pain, patient satisfaction, cost, infection and wound complications. We searched the databases MEDLINE, PubMed and Embase using the keywords 'skin surgery', 'dermatological surgery', 'sutures', 'braided sutures', 'monofilament sutures' and 'antibacterial sutures' to identify relevant English-language articles. This part of the review assesses the evidence for different types of buried sutures, including braided vs. monofilament sutures, longer-absorbing sutures and antibacterial sutures. The majority of trials were noted to be of poor quality, single-centre (thus lacking external validity) and underpowered, which presents challenges in comparing suture techniques in skin surgery. Future large-scale, multicentre, randomized trials are needed, with both surgeon and patient-assessed validated outcomes.
Assuntos
Procedimentos Cirúrgicos Dermatológicos/instrumentação , Procedimentos Cirúrgicos Dermatológicos/métodos , Técnicas de Sutura , Suturas , Antibacterianos/administração & dosagem , Cicatriz/prevenção & controle , Análise Custo-Benefício , Humanos , Dor/prevenção & controle , Preferência do Paciente , Satisfação do Paciente , Absorção Subcutânea , Infecção da Ferida Cirúrgica/prevenção & controle , Técnicas de Sutura/efeitos adversos , Técnicas de Sutura/economia , Suturas/economia , CicatrizaçãoRESUMO
Significant variation exists in the surgical suture materials and techniques used for dermatological surgery. Many wound-closure techniques are now practised, including use of sutures, staples and topical adhesives. The focus of our review article is to summarize the latest evidence relating to suture materials and wound-closure techniques, considering the following areas: scar/cosmesis, pain, patient satisfaction, cost, infection and wound complications. We searched the databases Medline, PubMed and Embase using the keywords 'skin surgery', 'dermatologic surgery', 'sutures', 'suture techniques', 'suturing techniques' and 'surgical techniques' to identify relevant English-language articles. Absorbable superficial sutures may be a preferred alternative to nonabsorbable sutures by both patients and surgeons. Subcuticular sutures may be preferable to simple interrupted sutures for superficial wound closure, and there may also be a role for skin staples in dermatological surgery, particularly on the scalp. However, there remains limited evidence specific to dermatological surgery supporting the use of particular suture materials and suturing techniques. Further high-quality research is required, including multicentre randomized trials with larger cohorts.
Assuntos
Procedimentos Cirúrgicos Dermatológicos/instrumentação , Procedimentos Cirúrgicos Dermatológicos/métodos , Técnicas de Sutura , Suturas , Cicatriz/prevenção & controle , Análise Custo-Benefício , Humanos , Dor/prevenção & controle , Preferência do Paciente , Satisfação do Paciente , Infecção da Ferida Cirúrgica , Técnicas de Sutura/efeitos adversos , Técnicas de Sutura/economia , Suturas/economia , CicatrizaçãoAssuntos
Carcinoma de Células Renais/secundário , Neoplasias de Cabeça e Pescoço/secundário , Neoplasias Renais/patologia , Couro Cabeludo/patologia , Neoplasias Cutâneas/secundário , Carcinoma de Células Renais/patologia , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Neoplasias Pulmonares/secundário , Masculino , Pessoa de Meia-Idade , Neoplasias Cutâneas/patologiaAssuntos
Procedimentos Cirúrgicos Dermatológicos/métodos , Suturas/estatística & dados numéricos , Suturas/tendências , Dermatologistas/estatística & dados numéricos , Humanos , Satisfação do Paciente , Padrões de Prática Médica , Cirurgia Plástica/estatística & dados numéricos , Inquéritos e Questionários , Suturas/economia , Reino Unido/epidemiologiaAssuntos
Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologia , Doença de Bowen/diagnóstico , Doença de Bowen/patologia , Carcinoma Basocelular/diagnóstico , Carcinoma Basocelular/patologia , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/patologia , Diagnóstico Diferencial , Histiocitoma Fibroso Benigno/diagnóstico , Histiocitoma Fibroso Benigno/patologia , Humanos , Hiperplasia/diagnóstico , Hiperplasia/patologia , Ceratoacantoma/diagnóstico , Ceratoacantoma/patologia , Nevo Intradérmico/diagnóstico , Nevo Intradérmico/patologia , Neoplasias Cutâneas/epidemiologia , Queimadura Solar/prevenção & controle , Protetores Solares/uso terapêutico , Reino Unido/epidemiologiaAssuntos
Procedimentos Cirúrgicos Dermatológicos , Violeta Genciana , Tinta , Pele , Clorexidina , Corantes , Detergentes , Humanos , IodoRESUMO
Consent must be undertaken prior to any dermatological procedure; however, in doing this, the clinician needs to ensure consent is valid and satisfies the principles of determining material risk. We aimed to assess variations in obtaining consent in the UK and understanding of material risk through a nationally distributed survey to members of the British Society for Dermatological Surgery and British Association of Dermatologists. Of 165 responses, we found that written consent was being obtained for all procedures in 73.9% of cases and typically at the time of procedure in the operating room/theatre (78.8%). Fifty-seven per cent of respondents were not familiar with the term 'material risk' and almost one-third were not aware of the Montgomery vs. Lanarkshire ruling, which replaced the Bolam test in 2015. We would encourage readers to be aware of these changes to consent law in the UK and how it might affect their approach to obtaining consent.
Assuntos
Dermatologistas , Consentimento Livre e Esclarecido , Padrões de Prática Médica , Pesquisas sobre Atenção à Saúde , Humanos , Reino UnidoRESUMO
This review forms part of a series of annual updates that summarize the evidence base for atopic eczema (AE). It provides a summary of key findings from 25 systematic reviews that were published or indexed during 2017, and focuses on the treatment and prevention of AE. There is high-quality evidence to demonstrate that dupilumab is better than placebo for the treatment of AE, is not associated with a higher incidence of adverse effects and does not increase the risk of infection compared with placebo; however, comparison studies with other systemic treatments are necessary. Topical tofacitinib is a promising treatment for mild-moderate AE, but currently lacks sufficient evidence from well-designed randomized controlled trials (RCTs) comparing with other active treatments. Topical doxepin may be effective for pruritus in AE, but available studies have short follow-up periods and longer-term outcomes are needed. Bleach baths were no more effective than water baths alone at reducing AE severity. Topical antibiotics cannot be recommended for infected AE, owing to insufficient evidence of benefit. There is little comparison of different emollients in RCTs, but overall evidence indicates that they reduce AE severity, are steroid-sparing and lead to better outcomes in combination with topical corticosteroids (TCS) than TCS alone. No clear benefit was demonstrated for vitamin D/C/E supplementation in pregnancy for eczema prevention.
Assuntos
Dermatite Atópica/tratamento farmacológico , Dermatite Atópica/prevenção & controle , Fármacos Dermatológicos/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Terapias Complementares , Dermatite Atópica/dietoterapia , Dermatite Atópica/psicologia , Emolientes , Feminino , Humanos , Gravidez , Revisões Sistemáticas como Assunto , Vitaminas/uso terapêuticoAssuntos
Pesquisa Biomédica/estatística & dados numéricos , Dermatologia/estatística & dados numéricos , Editoração/estatística & dados numéricos , Projetos de Pesquisa/estatística & dados numéricos , Pesquisa Biomédica/métodos , Dermatologia/métodos , Humanos , Fator de Impacto de Revistas , Inquéritos e Questionários/estatística & dados numéricosAssuntos
Acne Conglobata/complicações , Esclerite/complicações , Transtornos da Visão/etiologia , Acne Conglobata/tratamento farmacológico , Acne Conglobata/patologia , Fármacos Dermatológicos/administração & dosagem , Fármacos Dermatológicos/uso terapêutico , Humanos , Isotretinoína/administração & dosagem , Isotretinoína/uso terapêutico , Masculino , Esclerite/diagnóstico , Esclerite/patologia , Resultado do Tratamento , Transtornos da Visão/diagnóstico , Adulto JovemAssuntos
Antineoplásicos Imunológicos/efeitos adversos , Melanoma/tratamento farmacológico , Nivolumabe/efeitos adversos , Neoplasias Cutâneas/tratamento farmacológico , Líquen Escleroso Vulvar/induzido quimicamente , Idoso , Canal Anal , Anti-Inflamatórios/uso terapêutico , Clobetasol/uso terapêutico , Feminino , Humanos , Melanoma/secundário , Períneo , Neoplasias Cutâneas/patologia , Líquen Escleroso Vulvar/tratamento farmacológicoAssuntos
Hemofilia A/diagnóstico , Pênfigo/complicações , Rituximab/uso terapêutico , Administração Intravenosa , Anti-Inflamatórios/uso terapêutico , Ciclofosfamida/administração & dosagem , Ciclofosfamida/uso terapêutico , Feminino , Hemofilia A/sangue , Hemofilia A/etiologia , Hemofilia A/terapia , Humanos , Fatores Imunológicos/uso terapêutico , Imunossupressores/uso terapêutico , Pessoa de Meia-Idade , Pênfigo/sangue , Pênfigo/tratamento farmacológico , Pênfigo/patologia , Prednisolona/administração & dosagem , Prednisolona/uso terapêutico , Rituximab/administração & dosagem , Resultado do TratamentoRESUMO
BACKGROUND: The shedding of epithelial squames (skin scales) by staff in operating theatre air is an important source of deep infection following joint replacement surgery. This is a serious complication, resulting in significant morbidity for the patient and substantial cost implications for healthcare systems. Much effort has been put into providing clean air in operating theatres, yet little attention has been given to reducing the shedding of surface skin scales at source. AIM: To develop a novel method for calculating surface skin scale density using surface microscopy, and to use it to evaluate the effect of a skincare regimen on operating theatre staff. METHODS: Surface microscopy with Z-stacked imaging was used to visualize the effect of a skincare regimen involving three stages: washing with soap; exfoliation; and application of emollient. A USB microscope was then used in a field study to take images of the skin of operating theatre staff who applied the regimen to one lower limb the night before testing. The other limb was used as a control. Two blinded assessors analysed scale density. RESULTS: Z-stack images from the surface microscope enabled observations of the skincare regimen. The USB microscope also provided adequate images that enabled assessment of skin scale density. In the operating theatre staff, a 72.1% reduction in visible skin scales was observed following application of the skincare regimen. CONCLUSIONS: Further work is required to demonstrate how this effect correlates with dispersion of skin particles in a cleanroom, and subsequently in live operating theatre studies.