Antiseptic Use in Mohs and Reconstructive Surgery

Collins, Lindsey K.; Knackstedt, Thomas

doi:10.1097/dss.0000000000000202

Cited by 16 publications

(3 citation statements)

References 1 publication

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“…There are no definite guidelines for selecting an antiseptic solution for skin preparation in craniofacial surgery. Mohs surgeons use 4.0% chlorhexidine (Hibiclens) in 67.3% of the head and neck surgeries and 17.5% of the periocular surgeries 8 . When antiseptic solutions come in contact with the cornea, they can cause chemical injury to the ocular surface epithelium, cornea, anterior segment, and limbal stem cells.…”

Section: Discussionmentioning

confidence: 99%

Chemical Corneal Burn After Short Exposure to Alcohol-Containing Chlorhexidine Antiseptic

Lee,

Jun,

Lee

2023

Journal of Craniofacial Surgery

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Chlorhexidine is used routinely for asepsis in craniofacial surgeries. A solution containing a lower concentration of chlorhexidine diluted with alcohol has been developed to decrease chlorhexidine-related side effects. Herein, we report a case of chemical corneal burn caused by hexitanol solution (2% chlorhexidine + 72% ethanol) in a patient after undergoing closed reduction for nasal fracture under general anesthesia. Although the presumptive exposure time of the cornea was short, slit-lamp examination revealed epithelial defects. The patient received conservative care with extensive saline irrigation and conservative treatment with 0.3% gatifloxacin, 1% prednisolone, and carbomer eye drops. Among the various antiseptic solutions, ethanol markedly decreases cell viability in a concentration-dependent manner by inducing cell lysis, even after short exposure. Moreover, chlorhexidine induces corneal toxicity, necessitating corneal transplantation. Therefore, surgeons should be aware of the complications associated with the use of chlorhexidine or alcohol-containing antiseptics and the use povidone for its low ocular toxicity.

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Section: Discussionmentioning

confidence: 99%

Chemical Corneal Burn After Short Exposure to Alcohol-Containing Chlorhexidine Antiseptic

Lee,

Jun,

Lee

2023

Journal of Craniofacial Surgery

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“…Following informed consent and identification of the biopsy site, the patient is placed in a recumbent position, and the clinically evident tumor boundary or biopsy scar edges are marked with a surgical pen. Next, the operative field is cleansed with an antiseptic, such as chlorhexidine gluconate or povidone-iodine, and the patient is draped (Collins et al, 2015) (Wong et al, 2019). Of note, it is important to mark the surgical site prior to anesthetic infiltration to prevent margin distortion.…”

Section: Surgical Techniquementioning

confidence: 99%

Mohs Micrographic Surgery

Mastacouris

Mafee

2021

Journal of the Dermatology Nurses' Association

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Mohs micrographic surgery is a specialized surgical technique that involves serial excision of locally invasive, recurrent, or ill-defined skin cancers with complete histological examination of surgical margins. Originally developed by Dr. Frederic E. Mohs in the 1930s, it began as in situ tissue fixation with zinc chloride and healing by secondary intention and has evolved to fresh tissue surgical excision with subsequent reconstruction. Despite continuous advancements made in the field, the underlying principle of Mohs surgery remains the same: one surgeon acting as a pathologist to ensure complete tumor removal while minimizing the resection of healthy tissue. Mohs surgery is considered the gold standard for treatment of various cutaneous tumors and can be performed on an outpatient basis within a single day. The tumor is excised, mapped, and processed with frozen, horizontal sections for immediate histological evaluation and subsequent surgical staging in the location of a positive margin. This article serves as a review of Mohs surgery for dermatology nurses and offers an overview of the history of the procedure, clinical indications, preoperative assessments, surgical technique, reconstructive modalities, and postoperative care.

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“…Recently, it has been suggested that different prep solutions may pose varying risks to patients. For instance, 83% of surgical dermatologists use chlorhexidine on the face . On the one hand, it has been suggested that chlorhexidine use may contribute to the very low incidence of infection seen in cold-steel skin surgery and in minimally invasive cosmetic procedures such as filler injections.…”

mentioning

confidence: 99%

Association of Different Surgical Sterile Prep Solutions With Infection Risk After Cutaneous Surgery of the Head and Neck

et al. 2017

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Factors to be considered when selecting an optimal sterile prep solution prior to cutaneous surgery include the underlying health status of the patient, the expected extent of the surgery, the anatomic location of the tumor to be removed or planned reconstruction, and the inherent effectiveness of the prep solution. Recently, it has been suggested that different prep solutions may pose varying risks to patients. For instance, 83% of surgical dermatologists use chlorhexidine on the face. 1 On the one hand, it has been suggested that chlorhexidine use may contribute to the very low incidence of infection seen in coldsteel skin surgery and in minimally invasive cosmetic procedures such as filler injections. On the other hand, the ocular risks of chlorhexidine may outweigh the benefits. The purpose of this analysis was to compare the safety and effectiveness of prep solutions for skin surgery of the head and neck.

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Antiseptic Use in Mohs and Reconstructive Surgery

Cited by 16 publications

References 1 publication

Chemical Corneal Burn After Short Exposure to Alcohol-Containing Chlorhexidine Antiseptic

Chemical Corneal Burn After Short Exposure to Alcohol-Containing Chlorhexidine Antiseptic

Mohs Micrographic Surgery

Association of Different Surgical Sterile Prep Solutions With Infection Risk After Cutaneous Surgery of the Head and Neck

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