Prospective study of wound infections in Mohs micrographic surgery using clean surgical technique in the absence 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).…”

“…Accordingly, even in wounds that are at an increased risk of developing an infection, petrolatum should be used for postsurgical wound infection prophylaxis instead of topical antibiotics. Wounds located below the knees or in the groin region are associated with higher rates of surgical site infections, as are basal cell carcinoma and squamous cell carcinoma excisions, skin grafts, flaps on the nose or ear and wedge resections on the ear or lip (8,13,17,21,23,(27)(28)(29)(30)(31)(32)(33)49). Based on low-quality level C evidence from multiple large-scale case series (Table 3), the recommended classification for oral antibiotic prophylaxis against postsurgical infection of wounds created in these scenarios is grade 2B.…”

“…Additionally, articles that included patients who underwent surgeries not normally performed in the dermatologic outpatient setting were excluded. Finally, studies that included contaminated or infected wounds in their study samples were excluded since wounds created secondary to dermatologic procedures are typically classified as either clean or clean-contaminated (19)(20)(21). Information regarding the different surgical wound classifications can be found in Table 1.…”

Patient safety in dermatologic surgery

“…20 Recent evidence also reveals that infection rates are unaffected by the use of nonsterile compared to sterile gloves during MMS and reconstruction, reinforcing the safety of outpatient dermatologic surgery. [21][22][23] Because electrosurgery is an integral component of dermatologic surgery, it is also important to consider the safety of these methods on an outpatient basis. The primary concern with respect to electrosurgery is its potential interference with implantable electrical devices, namely cardiac pacemakers and defibrillators (ICDs).…”

Proper classification of surgical wounds

“…[3][4][5] It is this expanded definition that we reference in our paper. 6 Yet Dr Hirschman reminds us of two important points. First, that most dermatologic surgery wounds do not meet the criteria for clean-contaminated operative wounds any better than they meet the criteria for clean operative wounds.…”