Clean, non-contaminated skin surgery is associated with low rates of surgical site infection (SSI), bacterial endocarditis, and joint prosthesis infection. Hence, antibacterial prophylaxis, which may be associated with adverse effects, the emergence of multidrug-resistant pathogens, and anaphylaxis, is generally not recommended in dermatologic surgery. Some body sites and surgical reconstructive procedures are associated with higher infection rates, and guidelines for SSI antibacterial prophylaxis have been proposed for these cases. Large prospective, controlled trials are needed to ascertain the role of oral SSI prophylaxis for these surgical sites and procedures especially in patients with diabetes mellitus who are intrinsically at greater risk of SSI. Topical antibacterial ointment and sterile paraffin appear to make no difference to healing or the incidence of SSIs in clean wounds. Although further research is needed, preliminary studies have shown that intraincisional antibacterials, which may be associated with fewer adverse effects and a lower risk of multidrug-resistant bacteria, could potentially be helpful for SSI prophylaxis. Trials using honey- and silver-impregnated dressings have found no advantage in the healing of chronic wounds. However, several case studies, which need corroboration in larger studies, suggest that these dressings may be helpful in preventing and treating SSIs. Bacterial endocarditis and joint prosthesis infection prophylaxis are not routinely recommended in cutaneous surgery. The updated 2007 American Heart Association guidelines now advocate bacterial endocarditis prophylaxis for high-risk cardiac patients having surgery involving the oral mucosa or infected skin. The latest American Dental Association/American Academy of Orthopaedic Surgery guidelines recommend considering antibacterial prophylaxis for oral procedures where bleeding is anticipated and for surgery involving acute orofacial skin infections if the patient has had a total joint replacement within 2 years or is in a high-risk group and has had a joint replacement at any time.
Background:Studies show that patients are significantly less satisfied with torso scars than scars elsewhere. Though not an uncommon practice, it is unknown if application of adhesive tapes following dermatological surgery help improve cosmesis.Objective:To determine the effect of taping sutured torso wounds on overall scar appearance, scar width and patient satisfaction with the scar.Patients/Methods:Participants having elliptical torso skin excisions in a primary care setting in regional Australia were randomized in a single-blinded, controlled trial to 12 weeks taping (intervention) or usual care (control) following deep and subcuticular suturing. A blinded assessor reviewed scars at three and six months.Results:Of 195 participants recruited, 136 (63 taped, 73 controls) completed six months of follow-up. Independent blinded assessment of overall scar appearance was significantly better in taped participants (p= 0.004). Taping reduced median scar width by 1 mm (p=0.02) and when stratified by gender, by 3.0 mm in males (p=0.04) and 1.0 mm in females (p=0.2). High participant scar satisfaction was not further improved by taping.Conclusion:Taping elliptical torso wounds for 12 weeks after dermatologic surgery improved scar appearance at six months.
ObjectivesThere is limited published research studying the effect of antibiotic prophylaxis on surgical site infection (SSI) in dermatological surgery, and there is no consensus for its use in higher-risk cases. The objective of this study was to determine the effectiveness of a single oral preoperative 2 g dose of cephalexin in preventing SSI following flap and graft dermatological closures on the nose and ear.DesignProspective double-blinded, randomised, placebo-controlled trial testing for difference in infection rates.SettingPrimary care skin cancer clinics in North Queensland, Australia, were randomised to 2 g oral cephalexin or placebo 40–60 min prior to skin incision.Participants154 consecutive eligible patients booked for flap or graft closure following skin cancer excision on the ear and nose.Intervention2 g dose of cephalexin administered 40–60 min prior to surgery.ResultsOverall 8/69 (11.6%) controls and 1/73 (1.4%) in the intervention group developed SSI (p=0.015; absolute SSI reduction 10.2%; number needed to treat (NNT) for benefit 9.8, 95% CI 5.5 to 45.5). In males, 7/44 controls and 0/33 in the intervention group developed SSI (p=0.018; absolute SSI reduction 15.9%; NNT for benefit 6.3, 95% CI 3.8 to 19.2). SSI was much lower in female controls (1/25) and antibiotic prophylaxis did not further reduce this (p=1.0). There was no difference between the study groups in adverse symptoms attributable to high-dose antibiotic administration (p=0.871).ConclusionA single oral 2 g dose of cephalexin given before complex skin closure on the nose and ear reduced SSI.Trial registration numberANZCTR 365115; Post-results.
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