Wound Complications Following Diagnostic Skin Biopsies in Dermatology Inpatients

Abstract

To prospectively determine the wound complication rate for dermatology inpatients undergoing diagnostic skin biopsies during their admission and to determine significant host and procedural risk factors.Design: Prospective assessment, by a single observer, of 100 postdiagnostic skin biopsy wounds in dermatology inpatients. The following data were recorded for each patient: age and sex, presence of comorbidities, smoking status, dermatologic diagnosis, use of immunosuppressive or antibiotic therapy, place of biopsy (whether in the operation theater or in the ward), grade of physician performing biopsy, biopsy site on the body, type of biopsy (whether elliptical incision, punch, shave, or curettage), and wound closure technique.Main Outcome Measure: Wounds were designated as having had no complication or as being complicated by infection, dehiscence, and/or hematoma.Setting: A dedicated dermatology inpatient ward in a university teaching hospital.Results: Wound complications occurred in 29 (29%) biopsies, 27 (93%) of which were the result of wound infection. Complications occurred significantly more frequently when biopsies were performed below the waist compared with above the waist (PϽ.02), in the ward compared with the outpatient operating theater (P Ͻ.001), in smokers compared with nonsmokers (P Ͻ.001), and in those taking corticosteroids compared with those who were not (PϽ .001). In addition, elliptical incisional biopsies developed complications more frequently when subcutaneous sutures were not used compared with when they had been used (P Ͻ.001).Conclusions: This study has demonstrated a high rate of wound complications after diagnostic dermatologic surgery on dermatology inpatients with significant host and procedural risk factors. These findings are relevant for other centers with inpatient units where diagnostic biopsies are performed.

Antibiotic prophylaxis in dermatologic surgery: Advisory statement 2008

“…21 In addition, based on a study showing that infections were very common after skin biopsies in patients with extensive skin disease, due to colonization with S aureus, we recommend prophylaxis for surgical site infection in these patients as well. 23 Few studies offer suggestions for antibiotic regimens. We make recommendations based on organisms most likely to cause infection in the high-risk situations named.…”

Nikotinkonsum und plastische Chirurgie

“…Die Exzision und Primär-naht bei Pilonidalsinusoperationen ist signifikant mit einer erhöhten Komplikationsrate bei Rauchern gegenüber Nichtrauchern assoziiert [1]. Die Wundkomplikationsrate nach diagnostischen Hautbiopsien ist bei aktiven Rauchern gegenü-ber Nichtrauchern signifikant erhöht [31]. Bei Patienten, die sich wegen eines Lungenkarzinoms einer Lungenteilresektion unterzogen, war die 5-Jahres-Überlebens-rate mit 34% bei aktiven Rauchern gegenüber 56% bei Nichtrauchern eindeutig erniedrigt aufgrund von respiratorischem Versagen und kardiovaskulärer Komplikationen [17].…”

Guideline for Antimicrobial Prophylaxis in Breast Surgery

“…In breast and plastic surgery procedures, usually S. aureus is responsible for the wound infection (2,6,7,10,11,15,19,20). In axillary region procedures, obese patients prone to maceration, procedures at sweating areas P. aeruginosa, Serratia marcescens, Enterobacteriaceae including E. coli and gram-negatives like Klebsiella can be isolated (20, 21).…”

“…The risk of wound infection is below 5% in surgical procedures including breast reduction and reconstruction surgery, in a patient without additional risk factors for infection (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). In addition to patient specific conditions that are known to increase the risk of infection in all kinds of surgical wounds in general, the use of implants in breast surgery (13) and preoperative radiotherapy application (14,15) further increase the risk of wound infection.…”