Inherited bleeding disorders in dermatologic surgery

Complications in facial flap surgery

Local flaps are a common reconstructive technique of the head and neck. Consequently, knowledge of fundamental concepts and pitfalls to avoid will reduce surgical complications. These complications result from tension-related, ischemic, hematologic, and infectious causes. This paper seeks to address each of these causes with pearls to accomplish a successful outcome.

Newer hemostatic agents used in the practice of dermatologic surgery

Minor postoperative bleeding is the most common complication of cutaneous surgery. Because of the commonality of this complication, hemostasis is an important concept to address when considering dermatologic procedures. Patients that have a bleeding diathesis, an inherited/acquired coagulopathy, or who are on anticoagulant/antiplatelet medications pose a greater risk for bleeding complications during the postoperative period. Knowledge of these conditions preoperatively is of the utmost importance, allowing for proper preparation and prevention. Also, it is important to be aware of the various hemostatic modalities available, including electrocoagulation, which is among the most effective and widely used techniques. Prompt recognition of hematoma formation and knowledge of postoperative wound care can prevent further complications such as wound dehiscence, infection, or skin-graft necrosis, minimizing poor outcomes.

Hemorrhagic complications in dermatologic surgery

The ability to recognize, manage, and, most importantly, prevent hemorrhagic complications is critical to performing dermatologic procedures that have safe and high quality outcomes. This article reviews the preoperative, intraoperative, and postoperative factors and patient dynamics that are central to preventing such an adverse outcome. Specifically, the role that anticoagulants and anti-platelet agents, hypertension, and other medical conditions play in the development of postoperative hemorrhage are discussed. In addition, this article provides practical guidelines on managing bleeding during and after surgery.

Bleeding complications in dermatologic surgery

Although the overall incidence is low, bleeding complications in dermatologic surgery can occur and be the source of significant patient morbidity. In this article, we summarize the key aspects of preoperative assessment of patients at risk for bleeding. A review of current issues and literature regarding safe continuation of anticoagulant and antiplatelet medications in dermatologic surgery patients is also presented. In addition, principles for management of bleeding events, should they occur, are also highlighted.

Perioperative management of the patient with hematologic disorders

Bleeding at the time of surgery has the potential to become a serious complication. Careful patient assessment and review of history are of the utmost importance if this situation is to be avoided on the operating table. Unfortunately, many patients, particularly younger individuals with little to no previous exposure to surgery, are unaware of underlying bleeding disorders that they may have. Understanding the basic pathophysiology and management of these conditions becomes critical for the treating surgeon. For patients who have known conditions, close interconsultation with the treating hematologists and careful observation of preoperative, intraoperative, and postoperative established protocols reduces the risk of complications for patients and makes the possibility of success a reality for these individuals.

Perioperative management of von Willebrand disease in dermatologic surgery

BACKGROUND

Von Willebrand disease (VWD) is the most common inherited bleeding disorder, affecting an estimated 0.1% to 1% of the population. It is caused by a qualitative or quantitative defect of von Willebrand factor. Primary manifestations include intractable mucocutaneous bleeding after surgery or trauma.

OBJECTIVE

The objective was to review the pathophysiology and clinical features of VWD and to propose a perioperative management strategy for patients with this condition undergoing dermatologic surgery.

METHODS AND MATERIALS

Literature is reviewed.

RESULTS

The various types and clinical manifestations of this condition are reviewed, and a perioperative strategy is presented for managing patients with VWD who undergo cutaneous oncologic or cosmetic surgical procedures.

CONCLUSIONS

In most cases, dermatologic surgery can be safely performed in patients with VWD. The use of appropriate therapeutic prophylaxis in conjunction with a hematologist is indicated in high-risk, nonelective procedures.

Bleeding Complications in Dermatologic Surgery

Although the overall incidence is low, bleeding complications in dermatologic surgery can occur and be the source of significant patient morbidity. In this article, we summarize the key aspects of preoperative assessment of patients at risk for bleeding. A review of current issues and literature regarding safe continuation of anticoagulant and antiplatelet medications in dermatologic surgery patients is also presented. In addition, principles for management of bleeding events, should they occur, are also highlighted.

Hemorrhagic bullae after cryosurgery in a patient with hemophilia A

BACKGROUND

A case of hemorrhagic bullae and blisters on the hand of a patient with hemophilia A after cryosurgery for verruca vulgaris is reported.

OBJECTIVE

To discuss a hemorrhagic complication in a patient with hemophilia A after cutaneous cryosurgery.

METHODS

This is an observatory case report.

RESULTS

Even minimal cryosurgery can induce hemorrhagic bullae in patients with hemophilia A.

CONCLUSION

The risks and benefits of cryosurgery should be weighed carefully in patients with bleeding disorders such as hemophilia.