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Li S, Townes T, Na'ara S. Current Advances and Challenges in the Management of Cutaneous Squamous Cell Carcinoma in Immunosuppressed Patients. Cancers (Basel) 2024; 16:3118. [PMID: 39335091 PMCID: PMC11430974 DOI: 10.3390/cancers16183118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 08/23/2024] [Accepted: 09/06/2024] [Indexed: 09/30/2024] Open
Abstract
Cutaneous squamous cell carcinoma (cSCC) is the second most common skin malignancy and poses a significant risk to immunosuppressed patients, such as solid organ transplant recipients and those with hematopoietic malignancies, who are up to 100 times more likely to develop cSCC compared with the general population. This review summarizes the current state of treatment for cSCC in immunosuppressed patients, focusing on prevention, prophylaxis, surgical and non-surgical treatments, and emerging therapies. Preventative measures, including high-SPF sunscreen and prophylactic retinoids, are crucial for reducing cSCC incidence in these patients. Adjusting immunosuppressive regimens, particularly favoring mTOR inhibitors over calcineurin inhibitors, has been shown to lower cSCC risk. Surgical excision and Mohs micrographic surgery remain the primary treatments, with adjuvant radiation therapy recommended for high-risk cases. Traditional chemotherapy and targeted therapies like EGFR inhibitors have been utilized, though their efficacy varies. Immunotherapy, particularly with agents like cemiplimab and pembrolizumab, has shown promise, but its use in immunosuppressed patients requires further investigation due to potential risks of organ rejection and exacerbation of underlying conditions. Treatment of cSCC in immunosuppressed patients is multifaceted, involving preventive strategies, tailored surgical approaches, and cautious use of systemic therapies. While immunotherapy has emerged as a promising option, its application in immunosuppressed populations necessitates further research to optimize safety and efficacy. Future studies should focus on the integration of personalized medicine and combination therapies to improve outcomes for this vulnerable patient group.
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Affiliation(s)
- Sophie Li
- The Department of Head and Neck Surgery, MD Anderson Cancer Center, University of Texas, Houston, TX 77030, USA
| | - Thomas Townes
- The Department of Head and Neck Surgery, MD Anderson Cancer Center, University of Texas, Houston, TX 77030, USA
| | - Shorook Na'ara
- The Department of Head and Neck Surgery, MD Anderson Cancer Center, University of Texas, Houston, TX 77030, USA
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2
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Abril-Pérez C, Mansilla-Polo M, Escutia-Muñoz B, Sanmartín O, Garcés JR, Rodríguez-Prieto MA, Ruiz-Salas V, de Eusebio-Murillo E, Miñano-Medrano R, González-Sixto B, Artola-Igarza JL, Alfaro-Rubio A, Redondo P, Delgado-Jiménez Y, Sánchez-Schmidt JM, Allende-Markixana I, Alonso-Pacheco ML, García-Bracamonte B, de la Cueva-Dobao P, Navarro-Tejedor R, Ciudad-Blanco C, Carnero-González L, Vázquez-Veiga H, Cano-Martínez N, Serra-Guillén C, Vilarrasa E, Sánchez-Sambucety P, López-Estebaranz JL, Flórez-Menéndez Á, Martorell-Calatayud A, Gil P, Morales-Gordillo V, Toll A, Ocerin-Guerra I, Mayor-Arenal M, Suárez-Fernández R, Sainz-Gaspar L, Descalzo MA, Garcia-Doval I, Botella-Estrada R. Mohs micrographic surgery in immunosuppressed vs immunocompetent patients: Results of a prospective nationwide cohort study (REGESMOHS, Spanish registry of Mohs surgery). J Eur Acad Dermatol Venereol 2024. [PMID: 38733285 DOI: 10.1111/jdv.20103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/01/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Immunosuppressed (IS) patients, particularly solid organ transplant recipients and those on immunosuppressive therapy, face a higher incidence and recurrence of nonmelanoma skin cancers (NMSC), including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Mohs micrographic surgery (MMS) is the preferred treatment for high-risk NMSC due to its high cure rate and margin examination capabilities. However, IS patients may experience more complications, such as surgical site infections, and a greater risk of recurrence, making their outcomes a subject of interest. OBJECTIVES This study aimed to compare IS and immunocompetent (IC) patients undergoing MMS for NMSC in terms of baseline characteristics, intra- and post-surgical complications, and postoperative recurrence rates. METHODS The study utilized data from the REGESMOHS registry, a 7-year prospective cohort study in Spain. It included 5226 patients, categorizing them into IC (5069) and IS (157) groups. IS patients included solid organ transplant recipients, those on immunosuppressive treatments, individuals with haematological tumours and HIV-positive patients. Patient data, tumour characteristics, surgical details and outcomes were collected and analysed. RESULTS IS patients demonstrated a higher proportion of SCC, multiple synchronous tumours and tumours invading deeper structures. Complex closures, unfinished MMS and more surgical sections were observed in the IS group. Although intra-operative morbidity was higher among IS patients, this difference became non-significant when adjusted for other variables such as year of surgery, antiplatelet/anticoagulant treatment or type of closure. Importantly, IS patients had a substantially higher recurrence rate (IRR 2.79) compared to IC patients. CONCLUSIONS This study suggests that IS patients may be at a higher risk of development of AE such as bleeding or tumour necrosis and are at a higher risk of tumour recurrence. Close follow-up and consideration of the specific characteristics of NMSC in IS patients are crucial. Further research with extended follow-up is needed to better understand the long-term outcomes for this patient group.
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Affiliation(s)
- Carlos Abril-Pérez
- Hospital Universitario La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria La Fe (ISS La Fe), Valencia, Spain
| | - Miguel Mansilla-Polo
- Hospital Universitario La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria La Fe (ISS La Fe), Valencia, Spain
| | - Begoña Escutia-Muñoz
- Hospital Universitario La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria La Fe (ISS La Fe), Valencia, Spain
| | | | - Joan R Garcés
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Centro Médico Teknon, Barcelona, Spain
| | | | - Verónica Ruiz-Salas
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Centro Médico Teknon, Barcelona, Spain
| | | | | | - Beatriz González-Sixto
- Complexo Hospitalario Universitario de Pontevedra, Grupo de Investigación DIPO, IIS Galicia Sur-SERGAS-UVIGO, Pontevedra, Spain
| | | | | | | | - Yolanda Delgado-Jiménez
- Hospital Universitario Quirón Salud, Madrid, Spain
- Hospital Universitario de la Princesa, Madrid, Spain
| | | | | | | | | | | | | | - Cristina Ciudad-Blanco
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Hospital La Zarzuela, Madrid, Spain
| | | | - Hugo Vázquez-Veiga
- Complexo Hospitalario Universitario de Santiago, Santiago Compostela, Spain
| | | | | | - Eva Vilarrasa
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Centro Médico Teknon, Barcelona, Spain
| | | | | | - Ángeles Flórez-Menéndez
- Complexo Hospitalario Universitario de Pontevedra, Grupo de Investigación DIPO, IIS Galicia Sur-SERGAS-UVIGO, Pontevedra, Spain
| | | | - Pilar Gil
- Clínica Universidad de Navarra, Pamplona, Spain
| | | | | | | | | | | | - Laura Sainz-Gaspar
- Complexo Hospitalario Universitario de Santiago, Santiago Compostela, Spain
| | - Miguel A Descalzo
- Fundación Piel Sana Academia Española de Dermatología, Madrid, Spain
| | | | - Rafael Botella-Estrada
- Hospital Universitario La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria La Fe (ISS La Fe), Valencia, Spain
- Universidad de Valencia, Valencia, Spain
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3
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Richards E, Brown A, Wernham A. Review of infection and bleeding complications in excisional skin surgery. Clin Exp Dermatol 2024; 49:111-120. [PMID: 37798083 DOI: 10.1093/ced/llad339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/07/2023]
Abstract
Skin excision is the primary treatment for skin cancer. Complication rates from skin cancer excision are generally low but rates of complications may vary according to procedural complexity, site and patient factors. It is important that patients are fully informed through the consent process considering individual circumstances, the Montgomery ruling and material risks. The clinician must use an evidence-based approach to the consent process and assessment of risk. We have searched the literature and reviewed the current evidence regarding complications, and their incidence where data were available, following excisional skin surgery. This article aims to enable clinicians to better inform patients during the consent process about associated bleeding and infection risk.
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Affiliation(s)
- Ellen Richards
- Royal Devon University Healthcare NHS Trust, Exeter, Devon, UK
| | - Alistair Brown
- Royal Devon University Healthcare NHS Trust, Exeter, Devon, UK
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4
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Schlager JG, Patzer K, Wallmichrath J, French LE, Kunrad E, Schlingmann S, Stiefel D, Kendziora B, Hartmann D. Surgical site infection in skin surgery-An observational study. Int Wound J 2023; 20:3514-3522. [PMID: 37156639 PMCID: PMC10588314 DOI: 10.1111/iwj.14224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/21/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Surgical site infection (SSI) has a significant impact on patients' morbidity and aesthetic results. OBJECTIVE To identify risk factors for SSI in dermatologic surgery. PATIENTS AND METHODS This prospective, single-centre, observational study was performed between August 2020 and May 2021. Patients that presented for dermatologic surgery were included and monitored for the occurrence of SSI. For statistical analysis, we used a mixed effects logistic regression model. RESULTS Overall, 767 patients with 1272 surgical wounds were included in the analysis. The incidence of SSI was 6.1%. Significant risk factors for wound infection were defect size over 10cm2 (OR 3.64, 95% confidence interval [CI] 1.80-7.35), surgery of cutaneous malignancy (OR 2.96, CI 1.41-6.24), postoperative bleeding (OR 4.63, CI 1.58-13.53), delayed defect closure by local skin flap (OR 2.67, CI 1.13-6.34) and localisation of surgery to the ear (OR 7.75, CI 2.07-28.99). Wound localisation in the lower extremities showed a trend towards significance (OR 3.16, CI 0.90-11.09). Patient-related factors, such as gender, age, diabetes, or immunosuppression, did not show a statistically significant association with postoperative infection. CONCLUSION Large defects, surgery of cutaneous malignancy, postoperative bleeding, and delayed flap closure increase the risk for SSI. High-risk locations are the ears and lower extremities.
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Affiliation(s)
- Justin Gabriel Schlager
- Department of Dermatology and AllergyUniversity Hospital, Ludwig Maximilian University (LMU) MunichMunichGermany
| | - Kathrin Patzer
- Department of Dermatology and AllergyUniversity Hospital, Ludwig Maximilian University (LMU) MunichMunichGermany
| | - Jens Wallmichrath
- Department of Dermatology and AllergyUniversity Hospital, Ludwig Maximilian University (LMU) MunichMunichGermany
| | - Lars E. French
- Department of Dermatology and AllergyUniversity Hospital, Ludwig Maximilian University (LMU) MunichMunichGermany
- Dr. Philip Frost, Department of Dermatology and Cutaneous SurgeryUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Elena Kunrad
- Department of Dermatology and AllergyUniversity Hospital, Ludwig Maximilian University (LMU) MunichMunichGermany
| | - Sophia Schlingmann
- Department of Dermatology and AllergyUniversity Hospital, Ludwig Maximilian University (LMU) MunichMunichGermany
| | - Daniel Stiefel
- Department of Dermatology and AllergyUniversity Hospital, Ludwig Maximilian University (LMU) MunichMunichGermany
| | - Benjamin Kendziora
- Department of Dermatology and AllergyUniversity Hospital, Ludwig Maximilian University (LMU) MunichMunichGermany
| | - Daniela Hartmann
- Department of Dermatology and AllergyUniversity Hospital, Ludwig Maximilian University (LMU) MunichMunichGermany
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5
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Chen R, Krueger S, Flahive J, Mahmoud BH. Wound Care Adherence in Mohs Micrographic Surgery: A Prospective Cohort Study. Dermatol Surg 2023; 49:921-925. [PMID: 37506091 DOI: 10.1097/dss.0000000000003889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023]
Abstract
BACKGROUND Patients undergoing Mohs micrographic surgery (MMS) are given detailed wound care instructions to prevent postoperative complications. Previous studies have revealed low treatment adherence in general dermatology, but adherence to postoperative wound care and its potential association with poor surgical outcomes remain largely unstudied. OBJECTIVE To determine the frequency and causes of wound care nonadherence in patients who underwent MMS. MATERIALS AND METHODS A questionnaire containing a modified Eight-Item Morisky Medication Adherence Measure Scale was administered to Mohs patients at their 1 to 2 weeks postoperative visit. RESULTS Sixty-three patients were solicited and consented to completing the questionnaire. The average modified Eight-Item Morisky Medication Adherence Measure Scale score was 7.4 of 8, indicating high adherence. Old age and wound care assistance were associated with increased adherence. Factors contributing to nonadherence included feeling well, being too busy, wound care causing discomfort, and being with friends or family. One patient (1.6%) with high adherence developed an epidermal inclusion cyst within the scar. No other complications were observed. CONCLUSION Most MMS patients demonstrated high adherence to wound care instructions, and nonadherence was not associated with postoperative complications.
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Affiliation(s)
- Ryan Chen
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Steven Krueger
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Julie Flahive
- Department of Surgery, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Bassel H Mahmoud
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts
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Löser CR, Becker SL, Hartmann D, Kofler L, Kunte C, Müller CSL, Schlager JG, Balakirski G. Perioperative antibiotic prophylaxis in skin surgery - Position paper of the Antibiotic Stewardship working group of the German Society for Dermatologic Surgery (DGDC), Part 1: Procedure- and patient-related risk factors. J Dtsch Dermatol Ges 2023; 21:949-956. [PMID: 36892413 DOI: 10.1111/ddg.14947] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/13/2022] [Indexed: 03/10/2023]
Abstract
The aim of perioperative antibiotic prophylaxis (PAP) is to prevent the occurrence of surgical site infections (SSIs) or other infectious complications (especially bacterial endocarditis or septic arthritis). PAP is effective in surgeries where overall infection rates are high even without considering patient-related risk factors (such as orthopedic surgery or fracture repair). Surgery on airways, gastrointestinal, genital, or urinary tract is also considered to be associated with a risk of infection and may require PAP. Overall, SSIs in skin surgery are relatively rare and vary between 1% and 11% depending on the localization, complexity of the wound closure and patient cohort. Therefore, the general surgical recommendations regarding PAP only partially reflect the needs of dermatologic surgery. In contrast to the USA, where recommendations on the use of PAP in skin surgery already exist, there are currently no guidelines for the use of PAP specifically designed for dermatologic surgery in Germany. In the absence of an evidence-based recommendation, the use of PAP is guided by the experience of the surgeons and leads to a heterogeneous use of antimicrobial substances. In this work, we summarize the current scientific literature on the use of PAP and make a recommendation depending on procedure- and patient-related risk factors.
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Affiliation(s)
- Christoph R Löser
- Department of Dermatolgogy, Ludwigshafen City Hospital, Ludwigshafen
| | - Sören L Becker
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg
| | - Daniela Hartmann
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University Munich, Munich
| | - Lukas Kofler
- Department of Dermatology and Center for Dermatologic Surgery, Eberhard-Karls University of Tübingen, Tübingen
| | - Christian Kunte
- Department of Dermatologic Surgery and Dermatology, Artemed Clinic Munich, Munich
| | - Cornelia S L Müller
- Medical Supply Center for Histology, Cytology, and Molecular Diagnostics Trier, Trier
| | - Justin Gabriel Schlager
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University Munich, Munich
| | - Galina Balakirski
- Center for Dermatology, Allergology and Dermatosurgery, Helios University Hospital Wuppertal, University of Witten/Herdecke, Wuppertal
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Löser CR, Becker SL, Hartmann D, Kofler L, Kunte C, Müller CSL, Schlager JG, Balakirski G. Perioperative Antibiotikaprophylaxe in der Dermatochirurgie - Positionspapier der Arbeitsgruppe Antibiotic Stewardship der Deutschen Gesellschaft für Dermatochirurgie (DGDC), Teil 1: Eingriffs- und patientenbezogene Risikofaktoren. J Dtsch Dermatol Ges 2023; 21:949-957. [PMID: 37700414 DOI: 10.1111/ddg.14947_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/13/2022] [Indexed: 09/14/2023]
Abstract
ZusammenfassungDie perioperative Antibiotikaprophylaxe (PAP) hat das Ziel, postoperative Wundinfektionen und Infektionskomplikationen (insbesondere bakterielle Endokarditis oder septische Arthritis) bei chirurgischen Eingriffen zu vermeiden. Die PAP hat sich besonders bei Eingriffen bewährt, bei denen die Infektionsraten auch ohne Berücksichtigung der patientenbezogenen Risikofaktoren insgesamt hoch sind (wie für orthopädische Eingriffe oder die Versorgung von Frakturen). Auch Operationen mit Eröffnung der Atemwege, des Verdauungs‐, Genital‐ oder Harntrakts gelten als mit Infektionsrisiko behaftet und können eine PAP erfordern. In der Dermatochirurgie sind Infektionskomplikationen insgesamt verhältnismäßig selten und variieren in Abhängigkeit von der Lokalisation, Komplexität des Eingriffes und der Patientenkohorte zwischen 1% und 11%. Daher spiegeln die allgemeinchirurgischen Empfehlungen bezüglich der PAP die Bedürfnisse der Dermatochirurgie nur begrenzt wider. Im Gegensatz zu den USA, wo eine entsprechende Empfehlung vorliegt, existiert in Deutschland zurzeit keine speziell für dermatochirurgische Eingriffe konzipierte Leitlinie zur Anwendung von PAP. In Abwesenheit evidenzbasierter Empfehlungen wird die PAP durch die Erfahrung der einzelnen Operateure geprägt, was zu einer heterogenen Anwendung antimikrobieller Substanzen führt. In der vorliegenden Arbeit wird die aktuelle wissenschaftliche Literatur zu dem Thema zusammengefasst und die daraus resultierende Empfehlung zur Anwendung der PAP in Abhängigkeit von eingriffs‐ und patientenbezogenen Risikofaktoren formuliert.
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Affiliation(s)
- Christoph R Löser
- Hautklinik, Klinikum der Stadt Ludwigshafen am Rhein gGmbH, Ludwigshafen
| | - Sören L Becker
- Institut für Medizinische Mikrobiologie und Hygiene, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - Daniela Hartmann
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München
| | - Lukas Kofler
- Universitäts-Hautklinik, Universitätsklinikum Tübingen
| | - Christian Kunte
- Dermatochirurgie und Dermatologie, Artemed Fachklinik München GmbH & Co. KG, München
| | | | - Justin Gabriel Schlager
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München
| | - Galina Balakirski
- Zentrum für Dermatologie, Allergologie und Dermatochirurgie, Helios Universitätsklinikum Wuppertal, Universität Witten/Herdecke, Wuppertal
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Guo L, Zhu Z, Shi C, Jia Y, Nurzat Y, Su W, Zhang Y, Xu H. Drug suspending during wound healing effectively weakens immunosuppression-related complications by preserving CD8 + T cell function. Wound Repair Regen 2023; 31:489-499. [PMID: 37129099 DOI: 10.1111/wrr.13086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 05/03/2023]
Abstract
Immunosuppressive medications, which interfere with the activation and proliferation of T and B cells, increase the risk of wound healing complications. To address it, this study aimed to validate the feasibility of drug suspending during wound healing, whilst exploring the mechanisms exerted by T cells, which are important in the wound healing process. For this, a mouse skin wound model was set up. Tacrolimus (FK506) and fingolimod (FTY720) were both administered intraperitoneally prior to wounding to inhibit the T cell activation and migration, respectively. Flow-cytometric analysis subsequently revealed the functional T cell subtypes detected during the healing process. A CD8a antibody was also administered to deplete CD8+ T cells in vivo to verify their specific function. It was found that FK506 or FTY720 administration delayed the early phase of wound healing by reducing collagen production, which was also supported by the downregulation of col1a1, col3a1 and tgfb1. However, there was no significant difference in the total healing period. Both spleen- and skin-derived CD8+ T cells were proliferated and activated after injury without intervention, whereas CD4+ T cells showed no significant changes. Furthermore, selectively depleting CD8+ T cells retarded the healing process by downregulating collagen production-associated genes (col1a1, col3a1, tgfβ1 and en1) and proteins (collagen type 1 and 3). In addition, the CD8a antibody decreased the expression of genes lta, tnfa, il13 and il13ra, and protein interleukin-13Rα. In conclusion, suspending immunosuppressive drugs during wound healing was shown to be feasible through restraining the migration of activated T cells. CD8+ T cells represented the primary functional subtype positively associated with wound healing.
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Affiliation(s)
- Linxiumei Guo
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Lab of Tissue Engineering, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhu Zhu
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Lab of Tissue Engineering, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenchen Shi
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuxin Jia
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yeltai Nurzat
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weijie Su
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yixin Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Heng Xu
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Antibiotic Use and Surgical Site Infections in Immunocompromised Patients After Mohs Micrographic Surgery: A Single-Center Retrospective Study. Dermatol Surg 2022; 48:1283-1288. [DOI: 10.1097/dss.0000000000003620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
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10
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Schlager JG, Hartmann D, Wallmichrath J, Ruiz San Jose V, Patzer K, French LE, Kendziora B. Patient-dependent risk factors for wound infection after skin surgery: A systematic review and meta-analysis. Int Wound J 2022; 19:1748-1757. [PMID: 35229471 PMCID: PMC9615300 DOI: 10.1111/iwj.13780] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/13/2022] [Indexed: 12/02/2022] Open
Abstract
Postoperative wound infection in dermatologic surgery causes impaired wound healing, poor cosmetic outcome and increased morbidity. Patients with a high-risk profile may benefit from perioperative antibiotic prophylaxis. The objective of this systematic review was to identify risk factors for surgical site infection after dermatologic surgery. In this article, we report findings on patient-dependent risk factors. The literature search included MEDLINE, EMBASE, CENTRAL and trial registers. We performed meta-analysis, if studies reported sufficient data to calculate risk ratios with 95% confidence intervals. Study quality was assessed according to the Newcastle-Ottawa-Scale. Seventeen observational studies that analysed 31213 surgical wounds were eligible for inclusion. Fourteen studies qualified for meta-analysis. Nine studies showed good, three fair and five poor methodological quality. The reported incidence of surgical site infection ranged from 0.96% to 8.70%. Meta-analysis yielded that male gender and immunosuppression were significantly associated with higher infection rates. There was a tendency towards a higher infection risk for patients with diabetes, without statistical significance. Meta-analysis did not show different infection rates after excision of squamous cell carcinoma or basal cell carcinoma, but studies were substantially heterogenous. There was no significant association between risk for wound infection and smoking, age over 60 years, oral anti-aggregation or anti-coagulation or excision of malignant melanoma. In conclusion, the risk for surgical site infection in dermatologic surgery is low. Infection rates were increased significantly in male as well as immunosuppressed patients and non-significantly in diabetics.
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Affiliation(s)
- Justin Gabriel Schlager
- Department of Dermatology and AllergyUniversity Hospital, Ludwig Maximilian University (LMU) MunichMunichGermany
| | - Daniela Hartmann
- Department of Dermatology and AllergyUniversity Hospital, Ludwig Maximilian University (LMU) MunichMunichGermany
| | - Jens Wallmichrath
- Department of Dermatology and AllergyUniversity Hospital, Ludwig Maximilian University (LMU) MunichMunichGermany
| | - Virginia Ruiz San Jose
- Department of Ear, Nose and Throat (Otolaryngology)‐Head and Neck SurgeryUniversity Hospital AugsburgAugsburgGermany
| | - Kathrin Patzer
- Department of Dermatology and AllergyUniversity Hospital, Ludwig Maximilian University (LMU) MunichMunichGermany
| | - Lars Emil French
- Department of Dermatology and AllergyUniversity Hospital, Ludwig Maximilian University (LMU) MunichMunichGermany
- Dr. Philip Frost, Department of Dermatology and Cutaneous SurgeryUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Benjamin Kendziora
- Department of Dermatology and AllergyUniversity Hospital, Ludwig Maximilian University (LMU) MunichMunichGermany
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Hirahara N, Matsubara T, Kaji S, Uchida Y, Hyakudomi R, Yamamoto T, Takai K, Sasaki Y, Kawakami K, Tajima Y. Influence of nutrition on stage-stratified survival in gastric cancer patients with postoperative complications. Oncotarget 2022; 13:183-197. [PMID: 35079325 PMCID: PMC8782615 DOI: 10.18632/oncotarget.28179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/06/2022] [Indexed: 11/25/2022] Open
Abstract
Background: We assessed the relationship between preoperative prognostic nutritional index (PNI) and short- and long-term outcomes among gastric cancer patients because the clinical significance of PNI in these patients remains controversial. Materials and Methods: We retrospectively reviewed the medical records of 434 consecutive patients who underwent curative laparoscopic gastrectomy for gastric cancer. Results: Patients with postoperative complications had a significantly poorer overall survival (OS) than those without. On multivariate analyses, postoperative complications were independently associated with PNI value and operative procedure type. In the low PNI group (n = 118), those with postoperative complications experienced significantly poorer OS than those without complications. Among the low PNI group with pTNM stage I and II disease, those with postoperative complications experienced significantly worse OS than those without complications. However, among the high PNI group and patients with stage II and III disease in the low PNI group, OS was similar with respect to postoperative complications. Conclusions: The present study confirmed that long-term prognosis was unaffected by postoperative complications in well-nourished gastric cancer patients. In addition, preoperative nutritional status and postoperative complications, may be crucial in determining the prognosis of gastric cancer, especially in early-stage cancer.
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Affiliation(s)
- Noriyuki Hirahara
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Takeshi Matsubara
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Shunsuke Kaji
- Department of Surgery, Matsue Red Cross Hospital, Shimane, Matsue, Horomachi, Japan
| | - Yuki Uchida
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Ryoji Hyakudomi
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Tetsu Yamamoto
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Kiyoe Takai
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Yohei Sasaki
- Department of Surgery, Masuda Red Cross Hospital, Shimane, Masuda, Otoyoshi-cho, Japan
| | - Koki Kawakami
- Department of Surgery, Matsue Red Cross Hospital, Shimane, Matsue, Horomachi, Japan
| | - Yoshitsugu Tajima
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
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12
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Ruiz-Salas V, Sanmartin-Jiménez O, Garcés JR, Vilarrasa E, Miñano-Medrano R, Escutia-Muñoz B, Flórez-Menéndez Á, Artola-Igarza JL, Alfaro-Rubio A, Redondo P, Delgado-Jiménez Y, Sánchez-Schmidt J, Allende-Markixana I, García Bracamonte B, de la Cueva-Dobao P, Ciudad C, Carnero-González L, Vázquez-Veiga H, Sánchez-Sambucety P, Estebaranz JL, Botella-Estrada R, González-Sixto B, Martorell A, Morales-Gordillo V, Toll-Abelló A, Mayor-Arenal M, Suárez-Fernández R, Sainz-Gaspar L, Descalzo MA, Garcia-Doval I. Complications Associated with Mohs Micrographic Surgery: Data from the Nationwide Prospective Cohort REGESMOHS. Dermatology 2021; 238:320-328. [PMID: 34380138 DOI: 10.1159/000517010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/27/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Large prospective studies on the safety of Mohs micrographic (MMS) surgery are scarce, and most focus on a single type of surgical adverse event. Mid-term scar alterations and functional loss have not been described. OBJECTIVES To describe the risk of MMS complications and the risk factors for them. METHODS A nationwide prospective cohort collected all adverse events on consecutive patients in 22 specialised centres. We used multilevel mixed-effects logistic regression to find out factors associated with adverse events. RESULTS 5,017 patients were included, with 14,421 patient-years of follow-up. 7.0% had some perioperative morbidity and 6.5% had mid-term and scar-related complications. The overall risk of complications was mainly associated with use of antiaggregant/anticoagulant and larger tumours, affecting deeper structures, not reaching a tumour-free border, and requiring complex repair. Age and outpatient setting were not linked to the incidence of adverse events. Risk factors for haemorrhage (0.9%) were therapy with antiaggregant/anticoagulants, tumour size, duration of surgery, and unfinished surgery. Wound necrosis (1.9%) and dehiscence (1.0%) were associated with larger defects and complex closures. Immunosuppression was only associated with an increased risk of necrosis. Surgeries reaching deeper structures, larger tumours and previous surgical treatments were associated with wound infection (0.9%). Aesthetic scar alterations (5.4%) were more common in younger patients, with larger tumours, in H-area, and in flap and complex closures. Risk factors for functional scar alterations (1.7%) were the need for general anaesthesia, larger tumours that had received previous surgery, and flaps or complex closures. CONCLUSIONS MMS shows a low risk of complications. Most of the risk factors for complications were related to tumour size and depth, and the resulting need for complex surgery. Antiaggregant/anticoagulant intake was associated with a small increase in the risk of haemorrhage, that probably does not justify withdrawal. Age and outpatient setting were not linked to the risk of adverse events.
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Affiliation(s)
- Verónica Ruiz-Salas
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Centro Médico Teknon, Barcelona, Spain
| | | | - Joan R Garcés
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Centro Médico Teknon, Barcelona, Spain
| | - Eva Vilarrasa
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Centro Médico Teknon, Barcelona, Spain
| | | | | | | | | | | | | | - Yolanda Delgado-Jiménez
- Hospital Universitario Quirón Salud, Madrid, Spain.,Hospital Universitario de la Princesa, Madrid, Spain
| | | | | | | | | | - Cristina Ciudad
- Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Hospital La Zarzuela, Madrid, Spain
| | | | - Hugo Vázquez-Veiga
- Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | | | | | | | | | | | | | | | | | | | - Laura Sainz-Gaspar
- Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | | | - Ignacio Garcia-Doval
- Fundación Piel Sana Academia Española de Dermatología, Madrid, Spain.,Complexo Hospitalario Universitario de Vigo, Vigo, Spain
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13
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Electrosurgery Use During Post-Mohs Micrographic Surgery Repair and Complication Rates-How Important is a Dry Field? Dermatol Surg 2021; 47:1200-1204. [PMID: 34347693 DOI: 10.1097/dss.0000000000003119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Electrosurgery is used to achieve hemostasis during surgery. There are no studies exploring the effects of the use or avoidance of electrodessication during Mohs micrographic surgery (MMS) repair. Given the growing concerns for tissue aerosolization, occupational smoke exposure, and spread of infectious diseases, it is important to determine the importance of electrical hemostasis. MATERIALS AND METHODS In this retrospective study, electronic medical records of a single, tertiary, academic dermatology practice were reviewed. All MMS cases that underwent surgical repair from January 1 to December 31, 2019, by 2 dermatologic surgeons (one who used electrodessication during repair and one who did not) were included. Patient demographic data, information regarding the procedures, and complications occurring 90 days after MMS were recorded. RESULTS One hundred ninety-eight cases of MMS repair used electrodessication, whereas 193 cases did not. There was no significant difference in the demographic makeup, MMS procedure, or 90-day complication rates between the 2 groups. No major adverse events were MMS-related. CONCLUSION The use or avoidance of electrodessication during MMS repair was not associated with increased 90-day postoperative complications, suggesting that a greater tolerance of moderate oozing at a surgical site during MMS repair is reasonable to minimize electrosurgical tissue damage and occupational smoke exposure.
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14
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Keratinocyte Carcinoma Mortality in the United States as Reported in Death Certificates, 2011-2017. Dermatol Surg 2021; 46:1135-1140. [PMID: 31702593 DOI: 10.1097/dss.0000000000002261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKROUND Keratinocyte carcinoma (KC) mortality is relatively modest and its measures are subject to considerable error. Deaths due to KC have been decreasing through 2000 and were relatively stable until 2010. OBJECTIVE To estimate the KC mortality rates (MRs) from 2011 to 2017 in USA based on death certificates. METHODS A population-based analysis of Center of Disease Control and Prevention data. Main outcomes and measures were the age-adjusted (US 2000 standard population) MRs. RESULTS Overall, KC MRs increased significantly (b = 0.04, p < .01). For the period studied, KC MR was 1.24 per 100,000 persons per year (0.62 for sun-exposed sites, 0.38 for genital and 0.23 for perianal sites). At sun-exposed genital and perianal anatomic sites, KC MRs have been increasing in whites, but not in blacks. CONCLUSION There was a 17% decrease in the KC MRs until 2000, followed by an increase of 44% through 2017. The accuracy of KC MRs is uncertain. If indeed the increase in mortality is verified, causes may include an increase in KC incidence, an increase of immunosuppressed populations, and changes in the cause of death documentation.
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15
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Artamonova I, Schmitt L, Yazdi AS, Megahed M, Felbert V, Balakirski G. Postoperative Komplikationen bei dermatochirurgischen Patienten im Rahmen der stationären mikroskopisch‐kontrollierten Chirurgie: Eine monozentrische epidemiologische Studie. J Dtsch Dermatol Ges 2020; 18:1437-1448. [DOI: 10.1111/ddg.14148_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 02/25/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Inga Artamonova
- Abteilung für Orthopädie und Unfallchirurgie Marienhospital Brühl
- Klinik für Dermatologie und Allergologie Universitätsklinikum der RWTH Aachen
| | - Laurenz Schmitt
- Klinik für Dermatologie und Allergologie Universitätsklinikum der RWTH Aachen
| | - Amir S. Yazdi
- Klinik für Dermatologie und Allergologie Universitätsklinikum der RWTH Aachen
| | - Mosaad Megahed
- Klinik für Dermatologie und Allergologie Universitätsklinikum der RWTH Aachen
| | - Verena Felbert
- Klinik für Dermatologie und Allergologie Universitätsklinikum der RWTH Aachen
| | - Galina Balakirski
- Klinik für Dermatologie und Allergologie Universitätsklinikum der RWTH Aachen
- Klinik und Poliklinik für Dermatologie und Allergologie Universitätsklinikum Bonn
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16
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Liu A, Botkin A, Murray C, Solish N, Kitchen J, Chan AW. Outcomes of Staged Excision With Circumferential en Face Margin Control for Lentigo Maligna of the Head and Neck. J Cutan Med Surg 2020; 25:18-24. [PMID: 32911979 DOI: 10.1177/1203475420952425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Treatment practices vary for lentigo maligna (LM). Staged excision with circumferential margin control (SECMC) has the potential to achieve low recurrence rates. OBJECTIVES To evaluate the clinical outcomes of SECMC using permanent, paraffin-embedded sections and delayed reconstruction. METHODS We conducted a retrospective, uncontrolled, observational cohort study involving patients who underwent staged excision for LM of the head and neck at Women's College Hospital in Toronto, Canada, from September 2010 to March 2013. Recurrence and infection rates were ascertained from patient charts and postal surveys. RESULTS One hundred and two patients (45 female, 57 male) were included with a median follow-up time of 1410.5 (IQR 260-1756) days. The median age was 69 (IQR 61-79) years. Approximately one-fifth (21%, 21/102) of patients required greater than 0.5 cm margins to achieve histological clearance. One patient (1/102) upstaged to invasive melanoma based on the initial stage of excision. The infection rate was 6% (6/102) and the 5-year cumulative recurrence rate was 1.4% (95% CI 0.2-9.6%). CONCLUSION SECMC using permanent sections and delayed reconstruction appears to be a safe and effective treatment method for LM on the head and neck. Randomized trials are needed to help define the optimal treatment.
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Affiliation(s)
- Annie Liu
- 8664 Division of Dermatology, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Alexis Botkin
- 7938 Division of Dermatology, University of Toronto, Toronto, ON, Canada
| | - Christian Murray
- 8664 Division of Dermatology, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Nowell Solish
- 8664 Division of Dermatology, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Jessica Kitchen
- 7985 Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - An-Wen Chan
- 8664 Division of Dermatology, Women's College Hospital, University of Toronto, Toronto, ON, Canada
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17
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Artamonova I, Schmitt L, Yazdi AS, Megahed M, von Felbert V, Balakirski G. Postoperative complications in dermatological patients undergoing microscopically controlled surgery in inpatient setting (next-day surgery): A single-center epidemiological study. J Dtsch Dermatol Ges 2020; 18:1437-1446. [PMID: 32597032 DOI: 10.1111/ddg.14148] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 02/25/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Surgical site infections (SSI), bleeding, and necrosis are possible complications of dermatological surgery, and their rates are well described for Mohs surgery (same-day surgery). However, there are only limited data on their occurrence in microscopically controlled surgery of the form in which it is practiced in German hospitals (next-day surgery). MATERIALS AND METHODS We performed a retrospective analysis of patient records of patients hospitalized for microscopically controlled surgery during the year 2017 (12 months) in the Department of Dermatology and Allergology at the University Hospital of the RWTH Aachen (Aachen, Germany). The investigation addressed postoperative outcomes. RESULTS 319 patients underwent 528 dermatosurgical procedures in the defined period. Bleeding and necrosis occurred in 3.8 % (20/528) and 1.7 % (9/528) of the procedures, respectively. SSI occurred in 5.1 % (27/528) of the cases. The occurrence of bleeding was a statistically significant risk factor for SSI (p = 0.01). Furthermore, bleeding, SSI, and wound closure with a full-thickness graft were statistically significant risk factors for the development of necrosis (p < 0.05). Diabetes or immunosuppression were not found to be statistically significant risk factors for the development of SSI or necrosis after dermatologic surgery (p > 0.05). CONCLUSIONS Complication rates in microscopically controlled surgery (next-day surgery) are generally low and similar to those reported for Mohs surgery (same-day surgery). Therefore, it appears that some evidence-based perioperative recommendations that have been developed for Mohs surgery could be applied to German inpatient dermatosurgery. However, prospective studies with larger patient numbers are required to offer concrete recommendations specifically for microscopically controlled surgery (next-day surgery).
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Affiliation(s)
- Inga Artamonova
- Department of Orthopedics and Trauma Surgery, Marienhospital Brühl, Brühl, Germany.,Department of Dermatology and Allergology, University Hospital of RWTH Aachen, Aachen, Germany
| | - Laurenz Schmitt
- Department of Dermatology and Allergology, University Hospital of RWTH Aachen, Aachen, Germany
| | - Amir S Yazdi
- Department of Dermatology and Allergology, University Hospital of RWTH Aachen, Aachen, Germany
| | - Mosaad Megahed
- Department of Dermatology and Allergology, University Hospital of RWTH Aachen, Aachen, Germany
| | - Verena von Felbert
- Department of Dermatology and Allergology, University Hospital of RWTH Aachen, Aachen, Germany
| | - Galina Balakirski
- Department of Dermatology and Allergology, University Hospital of RWTH Aachen, Aachen, Germany.,Department of Dermatology and Allergology, University Hospital of Bonn, Bonn, Germany
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18
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Miller MQ, Stevens JS, Park SS, Christophel JJ. Do Postoperative Antibiotics Affect Outcomes in Mohs Reconstructive Surgery? Laryngoscope 2020; 131:E434-E439. [PMID: 32401393 DOI: 10.1002/lary.28700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 03/28/2020] [Accepted: 04/03/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS The prescribing of postoperative antibiotics for patients undergoing Mohs reconstructive surgery has increased in the last decade, while antibiotic resistance has been increasing. We hypothesized that routine prescribing of postoperative antibiotics after Mohs reconstruction does not decrease the risk of surgical site infection. STUDY DESIGN Retrospective, single-institution cohort study. METHODS This study assessed patients who underwent Mohs reconstructive surgery from January 1, 2012, to January 29, 2019. The main outcomes assessed included postoperative surgical site infections, partial or full flap/graft necrosis, hematoma, and dehiscence. RESULTS A total of 900 defects in 800 patients (mean age [range] = 65.3 [21-96], 54.60% female) were identified over the 7-year period. Patient-specific variables reviewed included comorbidities, age, and smoking status. Surgery-specific variables analyzed included defect characteristics, time interval between Mohs micrographic surgery and reconstruction, reconstructive modalities, and use of postoperative antibiotics. All patients received peri-incisional antibiotics. On regression analysis, use of cartilage grafts (odds ratio [OR]: 6.53; 95% CI: 2.1-20.6; P = .001), current smoking status (OR: 6.67; 95% CI: 2.09-21.30; P = .001), full-thickness defects (OR: 1.2; 95% CI: 1.0-3.4; P = .045), and interpolated flap reconstruction (OR: 3.4; 95% CI: 1.0-11.5; P = .049) were associated with an increased risk of postoperative infections. Smoking and cartilage grafting remained significant on bivariable regression modeling. Use of perioperative antibiotics was not associated with a decreased risk of infection (OR: 1.82; 95% CI: 0.23-14.21; P = .568). CONCLUSIONS We found no association between postoperative infections after Mohs reconstructive surgery and the use of postoperative antibiotics. These data support a more targeted approach to antibiotic prescribing in Mohs reconstructive surgery. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E434-E439, 2021.
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Affiliation(s)
- Matthew Q Miller
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, U.S.A
| | | | - Stephen S Park
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, U.S.A
| | - J Jared Christophel
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, U.S.A
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Abstract
Lung transplantation is an established therapeutic option for selected patients with advanced lung diseases. As early outcomes after lung transplantation have improved, chronic medical illnesses have emerged as significant obstacles to long-term survival. Among them is post-transplant malignancy, currently representing the 2nd most common cause of death 5–10 years after transplantation. Chronic immunosuppressive therapy and resulting impairment of anti-tumor immune surveillance is thought to have a central role in cancer development after solid organ transplantation (SOT). Lung transplant recipients receive more immunosuppression than other SOT populations, likely contributing to even higher risk of cancer among this group. The most common cancers in lung transplant recipients are non-melanoma skin cancers, followed by lung cancer and post-transplant lymphoproliferative disorder (PTLD). The purpose of this review is to outline the common malignancies following lung transplant, their risk factors, prognosis and current means for both prevention and treatment.
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Affiliation(s)
- Osnat Shtraichman
- Pulmonary, Allergy and Critical Care Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Pulmonary Institute, Rabin Medical Center, Affiliated with Sackler School of Medicine Tel Aviv University, Petach Tikva, Israel
| | - Vivek N Ahya
- Pulmonary, Allergy and Critical Care Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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20
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Ghias MH, Shamloul N, Khachemoune A. Dispelling myths in dermatologic surgery. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2019. [DOI: 10.15570/actaapa.2019.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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21
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Kyllo RL, Alam M. Risk, Prevention, Diagnosis, and Management of Post-Operative Cutaneous Infection. CURRENT DERMATOLOGY REPORTS 2019. [DOI: 10.1007/s13671-019-0257-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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