Prospective evaluation of surgical site infection rate among patients with Mohs micrographic surgery without the use of prophylactic antibiotics

Topical antibiotic prophylaxis for prevention of surgical wound infections from dermatologic procedures: a systematic review and meta-analysis

“…Since most wound infections occur as a result of contamination before wound closure, administering topical antibiotics postoperatively is not an effective measure to prevent postsurgical wound infections (34). The rates of postsurgical wound infection in the modern-day outpatient dermatologic setting are low, typically ranging from 0.7% to 4.0% (12)(13)(14)(15)18,21,23,27,28,31,32,(35)(36)(37)(38) even without prophylactic antibiotics secondary to current aseptic practices, such as preoperative surgical site preparation, sterilization of instruments and wearing gloves (4,22,(39)(40)(41). Furthermore, most of the wound infections that develop in this setting are mild and easily treated, frequently with basic wound care management alone and no antibiotics (34).…”

Prospective study of wound infections in Mohs micrographic surgery using clean surgical technique in the absence of prophylactic antibiotics

“…[5][6][7][8][9][10][11]13,15,16 Six of these studies include at least control arms where no antibiotic prophylaxis was used and the rates of SSIs remained low (0.72%-4.25%), providing strong evidence that antibiotics are not warranted for the majority of dermatologic surgery cases. [7][8][9][10]15,16 Yet, all of the studies to date used sterile technique at least during the wound reconstruction phase of the dermatologic surgeries. Our study is the first to identify the rate of SSI using clean surgical technique for all steps of MMS, including wound reconstruction, without antibiotic prophylaxis or topical antibiotics for postoperative wound care.…”

“…8 Our study is modeled after this study published by Maragh and Brown 8 in 2008 except that during the reconstruction of the defect instead of using sterile gloves and a new, sterile surgical tray as Maragh and Brown 8 did, we used clean gloves and the same surgical tray used earlier for taking the Mohs layers. The study of Maragh and Brown 8 reported a total rate of SSI of 0.72%, rate of SSI of flaps of 2.4%, and no SSIs of skin grafts or surgeries below the knee.…”

“…6,7 More recently, 3 studies have illustrated that this low rate of SSI is achievable without the use of prophylactic antibiotics, finding SSIs in 0.7%, 1.47%, and 1.8% of dermatologic surgeries. [8][9][10] When comparing these studies, each has its own surgical protocol to prevent infection. This variation can also be found when comparing the practices of Mohs surgeons.…”

Wound care in the dermatology office: Where are we in 2011?

“…This procedure may take up to several hours depending on the number of stages needed; however, postoperative infection rates for Mohs micrographic surgery have been reported as 1.1 to 2.45%. 48,50 Modern preoperative aseptic procedures such as surgical site preparation and hand washing have reduced infection rates to the extent that prophylactic antibiotics are no longer necessary, and may do more harm than good. 1 This observation is clinically relevant especially in regard to most commonly performed office-based dermatologic procedures.…”