Complications in skin grafts when continuing antithrombotic therapy prior to cutaneous surgery requiring skin grafting: A systematic review

Abstract

The risk of postoperative bleeding and wound healing complications in skin grafts among anticoagulated patients undergoing cutaneous surgery has not been firmly established. The objective was to examine the literature and assess the risk of postoperative bleeding or wound healing complications in skin grafts among anticoagulated patients, compared with patients who discontinue or patients who are not receiving antithrombotic therapy prior to cutaneous surgery requiring skin grafting. A systematic review examining the effect of antithrombotic therapy on cutaneous surgery was performed according to the PRISMA-guidelines. PubMed and Embase databases were primarily searched for relevant literature in the period from the start date of each database to 2014. A total of eight studies representing 443 patients met criteria for inclusion. No randomised controlled trials were found; the included studies were of prospective and retrospective design. Most of the reviewed studies suggest that the use of antithrombotic therapy can increase the risk of bleeding complications in skin grafts. These complications are only wound threatening and not life threatening. Therefore, this is of concern mostly in terms of hemostasis by the surgeon and good pressure dressings. Care should be taken when operating on anticoagulated patients undergoing cutaneous surgery requiring skin grafting. However, graft failure is rare and, given the risk of thrombotic events, the reviewed studies recommend continuing all medically necessary antithrombotic therapy. The limitations of this study are the small sample sizes and the level of evidence; hence, more research is needed to substantiate these preliminary findings.

Incidence of complications in dermatological surgery of melanoma and non-melanoma skin cancer in patients with multiple comorbidity and/or antiplatelet-anticoagulants. Five year experience in our Hospital

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“…Los resultados de esta revisión concuerdan con los previamente reportados en estudios similares 15 . La mayoría de los procedimientos se realizaron por cirujanos dermatólogos y residentes de dermatología.…”

Stepwise surgical approach to diabetic partial foot amputations with autogenous split thickness skin grafting

“…Appropriate hemostasis at the recipient wound bed is imperative since bleeding can lead to hematoma formation beneath the graft and may inhibit neoformed capillaries and therefore halt graft incorporation. Bleeding can be a concern in anticoagulated patients, which includes many diabetic patients; however, a systematic review by Jarjis et al revealed that skin graft failure is rare and that continuation of any medically necessary antithrombotic therapy is recommended in this population ( 14 ). Hemostasis can be achieved during wound bed preparation through meticulous tissue handling and strategic use of electrocautery.…”