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Sciegienka S, Slijepcevic A, Lipsey K, Spataro E, Chen C. Time to Mohs Reconstruction: A Systematic Review Comparing Complication Rates between Immediate and Delayed Repair. Facial Plast Surg 2024; 40:370-377. [PMID: 37336502 DOI: 10.1055/a-2112-7073] [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: 06/21/2023] Open
Abstract
Several known factors affect outcomes of Mohs facial defect reconstruction; however, the effect of repair timing on outcomes is ill-defined. The aim of this study was to determine postoperative complication rates between immediate and delayed repair of Mohs facial defects. Preferred Reporting Items of Systematic Reviews and Meta-Analyses guidelines were used. Articles were selected using PICO format-population: Mohs facial defect patients, intervention: defect repair, comparator: immediate (<24 hours), or delayed (>24 hours) repair, outcome: complication rate. PubMed/Medline (1946-2020), EMBASE (1947-2020), Scopus (1823-2020), Web of Science (1900-2020), Cochrane Library, and Clinicaltrials.gov were searched. Two independent reviewers screened abstracts; those in English with human subjects reporting repair timing and complication rates were included. Search criteria yielded 6,649 abstracts; 233 qualified for review. Data were gathered from six studies; they alone contained comparative data meeting inclusion criteria. While many well-written studies were encountered, reported results varied widely. A statistically sound meta-analysis could not be completed due to large heterogeneity between studies, biasing the analysis towards the largest weighted study. Clinically important differences may exist between immediate and delayed Mohs reconstruction, but small study numbers, large heterogeneity, and lack of standardized outcome measures limit definitive conclusions. More studies are needed to perform appropriate meta-analyses, including studies using standardized methods of reporting Mohs outcome data.
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Affiliation(s)
- Sebastian Sciegienka
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St Louis, Missouri
| | - Allison Slijepcevic
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Kim Lipsey
- Bernard Becker Medical Library, Washington University in St. Louis, St Louis, Missouri
| | - Emily Spataro
- Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine, St Louis, Missouri
| | - Collin Chen
- Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Saint Louis University School of Medicine, St Louis, Missouri
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Low-dose mesenchymal stem cell therapy for discogenic pain: safety and efficacy results from a 1-year feasibility study. Future Sci OA 2022; 8:FSO794. [PMID: 35662742 PMCID: PMC9136638 DOI: 10.2144/fsoa-2021-0155] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 03/22/2022] [Indexed: 11/23/2022] Open
Abstract
Aim: To evaluate safety and efficacy of low dose autologous adipose-derived mesenchymal stem cells (ADMSCs) for treatment of disc degeneration resulting in low back pain (LBP). Methods: Nine participants with chronic LBP originating from single-level lumbar disc disease underwent intradiscal injection of 10 million ADMSCs with optional repetition after 6 months. Results: No unexpected or serious adverse events were recorded. Seven (78%) of participants reported reductions in pain 12 months after treatment. Five (56%) reported increased work capacity. Three (33%) reduced analgesic medication. Improvements in EQ-5D and Oswestry disability index results were observed. MRI demonstrated no further disc degeneration and improvements to annular fissures and disc protrusions. Conclusion: This study provides initial evidence of safety and efficacy of ADMSCs for discogenic LBP.
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Nasb M, Liangjiang H, Gong C, Hong C. Human adipose-derived Mesenchymal stem cells, low-intensity pulsed ultrasound, or their combination for the treatment of knee osteoarthritis: study protocol for a first-in-man randomized controlled trial. BMC Musculoskelet Disord 2020; 21:33. [PMID: 31941483 PMCID: PMC6964002 DOI: 10.1186/s12891-020-3056-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 01/08/2020] [Indexed: 01/22/2023] Open
Abstract
Background Human adipose-derived Mesenchymal stem cells (HADMSCs) have proven their efficacy in treating osteoarthritis (OA), in earlier preclinical and clinical studies. As the tissue repairers are under the control of mechanical and biochemical signals, improving regeneration outcomes using such signals has of late been the focus of attention. Among mechanical stimuli, low-intensity pulsed ultrasound (LIPUS) has recently shown promise both in vitro and in vivo. This study will investigate the potential of LIPUS in enhancing the regeneration process of an osteoarthritic knee joint. Methods This study involves a prospective, randomized, placebo-controlled, and single-blind trial based on the SPIRIT guidelines, and aims to recruit 96 patients initially diagnosed with knee osteoarthritis, following American College of Rheumatology criteria. Patients will be randomized in a 1:1:1 ratio to receive Intraarticular HADMSCs injection with LIPUS, Intraarticular HADMSCs injection with shame LIPUS, or Normal saline with LIPUS. The primary outcome is Western Ontario and McMaster Universities Index of OA (WOMAC) score, while the secondary outcomes will be other knee structural changes, and lower limb muscle strength such as the knee cartilage thickness measured by MRI. Blinded assessments will be performed at baseline (1 month prior to treatment), 1 month, 3 months, and 6 months following the interventions. Discussion This trial will be the first clinical study to comprehensively investigate the safety and efficacy of LIPUS on stem cell therapy in OA patients. The results may provide evidence of the effectiveness of LIPUS in improving stem cell therapy and deliver valuable information for the design of subsequent trials. Trial registration This study had been prospectively registered with the Chinese Clinical Trials Registry. registration number: ChiCTR1900025907 at September 14, 2019.
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Affiliation(s)
- Mohammad Nasb
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.,Department of Physical Therapy, Health science faculty, Albaath University, Homs, Syria
| | - Huang Liangjiang
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Chenzi Gong
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Chen Hong
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.
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Heal C, Lepper P, Banks J. Topical antibiotics to prevent surgical site infection after minor surgery in primary care. Dermatol Pract Concept 2017; 7:16-20. [PMID: 29085715 PMCID: PMC5661155 DOI: 10.5826/dpc.0703a03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 04/28/2017] [Indexed: 11/26/2022] Open
Abstract
Background Surgical site infection (SSI) after minor surgery in primary care can compromise cosmetic outcomes, delay wound healing and increase costs. In addition to efficacy, adverse effects must be considered when considering antibiotic prophylaxis. There is no prior published literature regarding the proportion of general practitioners (GPs) who use topical antibiotics as SSI prophylaxis following minor surgery. Objectives To identify the proportion of GPs in a regional center in Queensland, Australia who apply topical antibiotics to wounds prevent SSIs after minor surgery. Method A database of 90 GPs was established, and they were invited to complete a questionnaire. Results The response rate was 62% (56/90). Topical antibiotics prophylaxis was reported as being used always or sometimes in routine practice by 18% (10/56) of participants after both skin lesion excision and repair of lacerations. In the context of high-risk situations, on the other hand, use was higher. They were more likely to be used in high-risk situations, most frequently in diabetic patients (41.0% [23/56]) and immunocompromised patients (46.5% [26/56]). Conclusions Evidence-based prescribing of antibiotics is vital. Topical antibiotic prophylaxis is often prescribed excessively after clean dermatological surgery, however, in our sample of GPs, only 18% used topical antibiotics always or sometimes in their practice.
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Affiliation(s)
- Clare Heal
- James Cook University, Mackay Base Hospital, Mackay, Australia
| | - Phoebe Lepper
- James Cook University, Mackay Base Hospital, Mackay, Australia
| | - Jennifer Banks
- James Cook University, Mackay Base Hospital, Mackay, Australia
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Freitag J, Li D, Wickham J, Shah K, Tenen A. Effect of autologous adipose-derived mesenchymal stem cell therapy in the treatment of a post-traumatic chondral defect of the knee. BMJ Case Rep 2017; 2017:bcr-2017-220852. [PMID: 29038190 PMCID: PMC5652344 DOI: 10.1136/bcr-2017-220852] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Isolated chondral defects have a limited capacity to heal and predispose to the development of osteoarthritis. Current surgical management can be unpredictable in outcome. Improved understanding of the action of mesenchymal stem cells (MSCs) has seen renewed interest in their role in cartilage repair. A 26-year-old athlete presented with a post-traumatic, isolated patella chondral defect. The patient underwent an arthroscopy with removal of a chondral loose body. After failure to symptomatically improve 12 months following surgery, the patient received intra-articular autologous adipose-derived mesenchymal stem cell (ADMSC) therapy.
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Affiliation(s)
- Julien Freitag
- Melbourne Stem Cell Centre, Box Hill, Victoria, Australia.,School of Biomedical Sciences, Charles Sturt University-Orange Campus, Orange, New South Wales, Australia.,Magellan Stem Cells, Box Hill North, Victoria, Australia
| | - Douglas Li
- Orthopaedic Associates Melbourne, East Melbourne, Victoria, Australia
| | - James Wickham
- School of Biomedical Sciences, Charles Sturt University-Orange Campus, Orange, New South Wales, Australia
| | - Kiran Shah
- Magellan Stem Cells, Box Hill North, Victoria, Australia
| | - Abi Tenen
- Magellan Stem Cells, Box Hill North, Victoria, Australia.,Monash University, Clayton, Victoria, Australia
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Freitag J, Shah K, Wickham J, Boyd R, Tenen A. The effect of autologous adipose derived mesenchymal stem cell therapy in the treatment of a large osteochondral defect of the knee following unsuccessful surgical intervention of osteochondritis dissecans - a case study. BMC Musculoskelet Disord 2017; 18:298. [PMID: 28705162 PMCID: PMC5513163 DOI: 10.1186/s12891-017-1658-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 07/05/2017] [Indexed: 12/18/2022] Open
Abstract
Background A prospective analysis of the effect of autologous adipose derived mesenchymal stem cell (MSC) therapy in the treatment of an osteochondral defect of the knee with early progressive osteoarthritis following unsuccessful surgical intervention of osteochondritis dissecans (OCD). Case presentation After failed conventional management of OCD a patient undergoes intra-articular MSC therapy. Patient outcome measures included the Numeric Pain Rating Scale (NPRS), the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Structural outcome was assessed using MRI with the novel technique of T2 mapping used to indicate cartilage quality. Following MSC therapy the patient reported improvement in pain and function as measured by NPRS, WOMAC and KOOS. Repeat MRI analysis showed regeneration of cartilage. MRI T2 mapping indicated hyaline like cartilage regrowth. Conclusion In this report, the use of MSCs, after unsuccessful conventional OCD management, resulted in structural, functional and pain improvement. These results highlight the need to further study the regenerative potential of MSC therapy. Trial registration Australian and New Zealand Clinical Trial Registry Number - ACTRN12615000258550 (Date registered 19/03/2015 – retrospectively registered).
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Heal CF, Banks JL, Lepper PD, Kontopantelis E, van Driel ML. Topical antibiotics for preventing surgical site infection in wounds healing by primary intention. Cochrane Database Syst Rev 2016; 11:CD011426. [PMID: 27819748 PMCID: PMC6465080 DOI: 10.1002/14651858.cd011426.pub2] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Surgical site infections (SSI) can delay wound healing, impair cosmetic outcome and increase healthcare costs. Topical antibiotics are sometimes used to reduce microbial contaminant exposure following surgical procedures, with the aim of reducing SSIs. OBJECTIVES The primary objective of this review was to determine whether the application of topical antibiotics to surgical wounds that are healing by primary intention reduces the incidence of SSI and whether it increases the incidence of adverse outcomes (allergic contact dermatitis, infections with patterns of antibiotic resistance and anaphylaxis). SEARCH METHODS In May 2015 we searched: the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL; the Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL. We also searched clinical trial registries for ongoing studies, and bibliographies of relevant publications to identify further eligible trials. There was no restriction of language, date of study or setting. The search was repeated in May 2016 to ensure currency of included studies. SELECTION CRITERIA All randomized controlled trials (RCTs) and quasi-randomised trials that assessed the effects of topical antibiotics (any formulation, including impregnated dressings) in people with surgical wounds healing by primary intention were eligible for inclusion. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies and independently extracted data. Two authors then assessed the studies for risk of bias. Risk ratios were calculated for dichotomous variables, and when a sufficient number of comparable trials were available, trials were pooled in a meta-analysis. MAIN RESULTS A total of 10 RCTs and four quasi-randomised trials with 6466 participants met the inclusion criteria. Six studies involved minor procedures conducted in an outpatient or emergency department setting; eight studies involved major surgery conducted in theatre. Nine different topical antibiotics were included. We included two three-arm trials, two four-arm trials and 10 two-arm trials. The control groups comprised; an alternative topical antibiotic (two studies), topical antiseptic (six studies) and no topical antibiotic (10 studies), which comprised inert ointment (five studies) no treatment (four studies) and one study with one arm of each.The risk of bias of the 14 studies varied. Seven studies were at high risk of bias, five at unclear risk of bias and two at low risk of bias. Most risk of bias concerned risk of selection bias.Twelve of the studies (6259 participants) reported infection rates, although we could not extract the data for this outcome from one study. Four studies (3334 participants) measured allergic contact dermatitis as an outcome. Four studies measured positive wound swabs for patterns of antimicrobial resistance, for which there were no outcomes reported. No episodes of anaphylaxis were reported. Topical antibiotic versus no topical antibioticWe pooled the results of eight trials (5427 participants) for the outcome of SSI. Topical antibiotics probably reduce the risk of SSI in people with surgical wounds healing by primary intention compared with no topical antibiotic (RR 0.61, 95% CI 0.42 to 0.87; moderate-quality evidence downgraded once for risk of bias). This equates to 20 fewer SSIs per 1000 patients treated with topical antibiotics (95% CI 7 to 29) and a number needed to treat for one additional beneficial outcome (NNTB) (i.e. prevention of one SSI) of 50.We pooled the results of three trials (3012 participants) for the outcome of allergic contact dermatitis, however this comparison was underpowered, and it is unclear whether topical antibiotics affect the risk of allergic contact dermatitis (RR 3.94, 95% CI 0.46 to 34.00; very low-quality evidence, downgraded twice for risk of bias, once for imprecision). Topical antibiotic versus antiseptic We pooled the results of five trials (1299 participants) for the outcome of SSI. Topical antibiotics probably reduce the risk of SSI in people with surgical wounds healing by primary intention compared with using topical antiseptics (RR 0.49, 95% CI 0.30 to 0.80; moderate-quality evidence downgraded once for risk of bias). This equates to 43 fewer SSIs per 1000 patients treated with topical antibiotics instead of antiseptics (95% CI 17 to 59) and an NNTB of 24.We pooled the results of two trials (541 participants) for the outcome of allergic contact dermatitis; there was no clear difference in the risk of dermatitis between topical antibiotics and antiseptics, however this comparison was underpowered and a difference cannot be ruled out (RR 0.97, 95% CI 0.52 to 1.82; very low-quality evidence, downgraded twice for risk of bias and once for imprecision). Topical antibiotic versus topical antibioticOne study (99 participants) compared mupirocin ointment with a combination ointment of neomycin/polymyxin B/bacitracin zinc for the outcome of SSI. There was no clear difference in the risk of SSI, however this comparison was underpowered (very low-quality evidence downgraded twice for risk of bias, once for imprecision).A four-arm trial involved two antibiotic arms (neomycin sulfate/bacitracin zinc/polymyxin B sulphate combination ointment versus bacitracin zinc, 219 participants). There was no clear difference in risk of SSI between the combination ointment and the bacitracin zinc ointment. The quality of evidence for this outcome was low, downgraded once for risk of bias, and once for imprecision. AUTHORS' CONCLUSIONS Topical antibiotics applied to surgical wounds healing by primary intention probably reduce the risk of SSI relative to no antibiotic, and relative to topical antiseptics (moderate quality evidence). We are unable to draw conclusions regarding the effects of topical antibiotics on adverse outcomes such as allergic contact dermatitis due to lack of statistical power (small sample sizes). We are also unable to draw conclusions regarding the impact of increasing topical antibiotic use on antibiotic resistance. The relative effects of different topical antibiotics are unclear.
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Affiliation(s)
- Clare F Heal
- James Cook UniversityGeneral Practice and Rural MedicineMackay Base HospitalBridge RoadMackayQueenslandAustralia4740
- Anton Breinl Research Centre for Health Systems StrengtheningTownsvilleQueenslandAustralia
| | - Jennifer L Banks
- James Cook UniversitySchool of Medicine and DentistryMackayQueenslandAustralia4740
| | - Phoebe D Lepper
- James Cook UniversitySchool of Medicine and DentistryMackayQueenslandAustralia4740
| | - Evangelos Kontopantelis
- The University of ManchesterCentre for Health Informatics, Institute of Population HealthWilliamson Building, 5th FloorOxford RoadManchesterGreater ManchesterUKM13 9PL
| | - Mieke L van Driel
- The University of QueenslandDiscipline of General Practice, School of MedicineBrisbaneQueenslandAustralia4029
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Freitag J, Ford J, Bates D, Boyd R, Hahne A, Wang Y, Cicuttini F, Huguenin L, Norsworthy C, Shah K. Adipose derived mesenchymal stem cell therapy in the treatment of isolated knee chondral lesions: design of a randomised controlled pilot study comparing arthroscopic microfracture versus arthroscopic microfracture combined with postoperative mesenchymal stem cell injections. BMJ Open 2015; 5:e009332. [PMID: 26685030 PMCID: PMC4691736 DOI: 10.1136/bmjopen-2015-009332] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 10/25/2015] [Accepted: 10/26/2015] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The management of intra-articular chondral defects in the knee remains a challenge. Inadequate healing in areas of weight bearing leads to impairment in load transmission and these defects predispose to later development of osteoarthritis. Surgical management of full thickness chondral defects include arthroscopic microfracture and when appropriate autologous chondrocyte implantation. This latter method however is technically challenging, and may not offer significant improvement over microfracture. Preclinical and limited clinical trials have indicated the capacity of mesenchymal stem cells to influence chondral repair. The aim of this paper is to describe the methodology of a pilot randomised controlled trial comparing arthroscopic microfracture alone for isolated knee chondral defects versus arthroscopic microfracture combined with postoperative autologous adipose derived mesenchymal stem cell injections. METHODS AND ANALYSIS A pilot single-centre randomised controlled trial is proposed. 40 participants aged 18-50 years, with isolated femoral condyle chondral defects and awaiting planned arthroscopic microfracture will be randomly allocated to a control group (receiving no additional treatment) or treatment group (receiving postoperative adipose derived mesenchymal stem cell treatment). Primary outcome measures will include MRI assessment of cartilage volume and defects and the Knee Injury and Osteoarthritis Outcome Score. Secondary outcomes will include further MRI assessment of bone marrow lesions, bone area and T2 cartilage mapping, a 0-10 Numerical Pain Rating Scale, a Global Impression of Change score and a treatment satisfaction scale. Adverse events and cointerventions will be recorded. Initial outcome follow-up for publication of results will be at 12 months. Further annual follow-up to assess long-term differences between the two group will occur. ETHICS AND DISSEMINATION This trial has received prospective ethics approval through the Latrobe University Human Research Ethics Committee. Dissemination of outcome data is planned through both national and international conferences and formal publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER Australia and New Zealand Clinical Trials Register (ANZCTR Trial ID: ACTRN12614000812695).
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Affiliation(s)
- Julien Freitag
- Melbourne Stem Cell Centre, Melbourne, Victoria, Australia
| | - Jon Ford
- Faculty of Health Sciences, La Trobe University, Melbourne, Victoria, Australia
| | - Dan Bates
- Melbourne Stem Cell Centre, Melbourne, Victoria, Australia
| | - Richard Boyd
- Monash University, Melbourne, Victoria, Australia
| | - Andrew Hahne
- Faculty of Health Sciences, La Trobe University, Melbourne, Victoria, Australia
| | - Yuanyuan Wang
- Department of Epidemiology and Preventative Medicine, Monash Universty, Melbourne, Victoria, Australia
| | - Flavia Cicuttini
- Department of Epidemiology and Preventative Medicine, Monash Universty, Melbourne, Victoria, Australia
| | - Leesa Huguenin
- Melbourne Stem Cell Centre, Melbourne, Victoria, Australia
| | - Cameron Norsworthy
- Department of Orthopaedic Surgeon, OrthoSport Victoria, Melbourne, Victoria, Australia
| | - Kiran Shah
- Magellan Stem Cells, Melbourne, Victoria, Australia
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Saco M, Howe N, Nathoo R, Cherpelis B. Topical antibiotic prophylaxis for prevention of surgical wound infections from dermatologic procedures: a systematic review and meta-analysis. J DERMATOL TREAT 2014; 26:151-8. [DOI: 10.3109/09546634.2014.906547] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bağhaki S, Soybir GR, Soran A. Guideline for Antimicrobial Prophylaxis in Breast Surgery. THE JOURNAL OF BREAST HEALTH 2014; 10:79-82. [PMID: 28331648 DOI: 10.5152/tjbh.2014.1959] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 12/19/2013] [Indexed: 11/22/2022]
Abstract
The American Society of Health-System Pharmacists (ASHP) published the 2012/2013 edition of the book entitled "Best Practices for Hospital & Health-System Pharmacy: Position and Guidance Documents of ASHP" with Bruce Hawkins as the editor. (ISSN: 15558975). Pages 582-667 of this book contain the section: "Therapeutic Guidelines on Antimicrobial Prophylaxis in Surgery". This section includes current clinical developments, evidence and recommendations on the application of standard and effective antimicrobial prophylaxis in adult and pediatric patients, and has significant differences compared to the previous 1999 edition. On pages 632-633, antimicrobial prophylaxis in breast and plastic surgery practice is addressed in detail. This article contains a summary of the recommendations made in ASHP 2012/2013 Report regarding the antimicrobial prophylaxis in breast and plastic surgery applications.
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Affiliation(s)
- Sema Bağhaki
- İstanbul Bilim University Faculty of Medicine, İstanbul, Turkey
| | - Gürsel Remzi Soybir
- Department of General Surgery, Namık Kemal University Faculty of Medicine, Tekirdağ, Turkey
| | - Atilla Soran
- Magee-Womens Hospital, Pittsburgh University, Pittsburgh, USA
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O'Neill JL, Lee YS, Solomon JA, Patel N, Shutty B, Davis SA, Robins DN, Williford PM, Feldman SR, Pearce DJ. Quantifying and Characterizing Adverse Events in Dermatologic Surgery. Dermatol Surg 2013; 39:872-8. [DOI: 10.1111/dsu.12165] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt) 2013; 14:73-156. [PMID: 23461695 DOI: 10.1089/sur.2013.9999] [Citation(s) in RCA: 690] [Impact Index Per Article: 62.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Dale W Bratzler
- College of Public Health, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma 73126-0901, USA.
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Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013; 70:195-283. [DOI: 10.2146/ajhp120568] [Citation(s) in RCA: 1364] [Impact Index Per Article: 124.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Manuskiatti W, Iamphonrat T, Wanitphakdeedecha R, Eimpunth S. Comparison of Fractional Erbium-Doped Yttrium Aluminum Garnet and Carbon Dioxide Lasers in Resurfacing of Atrophic Acne Scars in Asians. Dermatol Surg 2013. [DOI: 10.1111/dsu.12030] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rossi AM, Mariwalla K. Prophylactic and Empiric Use of Antibiotics in Dermatologic Surgery: A Review of the Literature and Practical Considerations. Dermatol Surg 2012; 38:1898-921. [DOI: 10.1111/j.1524-4725.2012.02524.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Elliott TG, Thom GA, Litterick KA. Office based dermatological surgery and Mohs surgery: a prospective audit of surgical procedures and complications in a procedural dermatology practice. Australas J Dermatol 2012; 53:264-71. [PMID: 23043516 DOI: 10.1111/j.1440-0960.2012.00951.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 07/24/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Dermatologists commonly perform surgical procedures, including Mohs micrographic surgery, in an outpatient, office-based setting. Although this may be widely perceived to be safe and effective, formal data on the practice are limited. The aim of this study was to examine the range of surgical procedures and associated complications in an Australian specialist dermatology and Mohs surgery practice. METHODS All surgical procedures over a 55-week period were prospectively logged, with data collection on sex, age, type of procedure, body site, diagnosis and complications. All procedures were performed under conditions that were usual for the practice, with a combination of sterile and clean surgical techniques, depending on the procedure. RESULTS In all, 2370 surgical procedures were performed during the study period, including 934 Mohs surgery cases. Most procedures (68%) were performed on head and neck sites. A total of 56 complications were recorded in 51 patients. Bacterial wound infections occurred in 13 cases (0.5%). Bleeding complications occurred in five cases (0.2%). There were no complications requiring hospital admission or i.v. antibiotics. CONCLUSIONS This study supports the view that dermatological surgery, including significant procedures such as Mohs micrographic surgery, flaps and grafts, can be performed on an ambulatory basis in an office-based procedure room setting, with low complication rates.
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Affiliation(s)
- Timothy G Elliott
- South Perth Specialist Skin Cancer Centre, 38 Meadowvale Avenue, South Perth, WA 6151, Australia.
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Heal CF, Buettner PG, Drobetz H. Risk factors for surgical site infection after dermatological surgery. Int J Dermatol 2012; 51:796-803. [DOI: 10.1111/j.1365-4632.2011.05189.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Complications in surgery are an unfavorable outcome as a result of a procedure. These can occur intraoperatively, immediately after or in the distant future. Minimizing the risk and prompt treatment of complications is important to avoid potentially disastrous outcomes. This article will review the more common complications of cutaneous surgery and then analyze the legal consequences of these complications.
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Affiliation(s)
- Jeremy Man
- Skin Laser and Surgery Specialists of New York and New Jersey, USA
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Rosengren H, Heal C, Smith S. An Update on Antibiotic Prophylaxis in Dermatologic Surgery. CURRENT DERMATOLOGY REPORTS 2012. [DOI: 10.1007/s13671-012-0012-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Levender MM, Davis SA, Kwatra SG, Williford PM, Feldman SR. Use of topical antibiotics as prophylaxis in clean dermatologic procedures. J Am Acad Dermatol 2012; 66:445-51. [PMID: 21821310 DOI: 10.1016/j.jaad.2011.02.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2010] [Revised: 01/06/2011] [Accepted: 02/02/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Topical antibiotics are not indicated for routine postoperative care in clean dermatologic procedures, but may be widely used. OBJECTIVE We sought to describe topical antibiotic use in clean dermatologic surgical procedures in the United States. METHODS The 1993 to 2007 National Ambulatory Medical Care Survey database was queried for visits in which clean dermatologic surgery was performed. We analyzed provider specialty, use of topical antibiotics, and associated diagnoses. Use of topical antibiotic over time was analyzed by linear regression. RESULTS An estimated 212 million clean dermatologic procedures were performed between 1993 and 2007; topical antibiotics were reported in approximately 10.6 million (5.0%) procedures. Dermatologists were responsible for 63.3% of dermatologic surgery procedures and reported use of topical antibiotic prophylaxis in 8.0 million (6.0%). Dermatologists were more likely to use topical antibiotic prophylaxis than nondermatologists (6.0% vs 3.5%). Use of topical antibiotic prophylaxis decreased over time. LIMITATIONS Data were limited to outpatient procedures. The assumption was made that when topical antibiotics were documented at procedure visits they were being used as prophylaxis. CONCLUSIONS Topical antibiotics continue to be used as prophylaxis in clean dermatologic procedures, despite being ineffective for this purpose and posing a risk to patients. Although topical antibiotic use is decreasing, prophylactic use should be eliminated.
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Affiliation(s)
- Michelle M Levender
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1071, USA.
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Pomerantz RG, Lee DA, Siegel DM. Risk assessment in surgical patients: balancing iatrogenic risks and benefits. Clin Dermatol 2011; 29:669-77. [DOI: 10.1016/j.clindermatol.2011.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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22
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Reply. J Am Acad Dermatol 2011. [DOI: 10.1016/j.jaad.2010.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Draelos ZD, Rizer RL, Trookman NS. A comparison of postprocedural wound care treatments: do antibiotic-based ointments improve outcomes? J Am Acad Dermatol 2011; 64:S23-9. [PMID: 21247662 DOI: 10.1016/j.jaad.2010.11.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 09/02/2010] [Accepted: 11/01/2010] [Indexed: 11/24/2022]
Abstract
BACKGROUND Topical antibiotic ointments are commonly used for the postprocedural treatment of superficial wounds created during dermatologic procedures. We propose that antibiotics may not be necessary for healing these wounds, have the potential to cause allergic contact dermatitis, and may contribute to the development of antibiotic resistance. OBJECTIVE We sought to compare the efficacy and safety of a nonantibiotic, petrolatum-based ointment (Aquaphor Healing Ointment [AHO], Beiersdorf Inc, Wilton, CT) and an antibiotic-based first-aid ointment (Polysporin [Poly/Bac], Johnson & Johnson, New Brunswick, NJ) for the treatment of wounds created by removal of seborrheic keratoses. METHODS In this double-blind study, 30 subjects each had two seborrheic keratoses removed from their trunk or abdomen; one wound was treated with AHO and one with Poly/Bac twice daily. Clinical grading of wound healing and subjective irritation was assessed at days 7, 14, and 28 postwounding. Adverse events were recorded. RESULTS Clinical grading assessment showed no differences between wounds treated with AHO versus Poly/Bac for erythema, edema, epithelial confluence, crusting, and scabbing at any time point. Subjective irritation assessment showed wounds treated with Poly/Bac had a significant increase in burning at week 1, whereas no differences were seen between treatments for stinging, itching, tightness, tingling, or pain. One case of allergic contact dermatitis was reported after Poly/Bac treatment. LIMITATIONS This was a relatively small study. CONCLUSIONS This study demonstrated that the petrolatum-based skin protectant ointment AHO provided equivalent efficacy for wound healing as a combination antibiotic first-aid ointment. Antibiotics may not be necessary to achieve satisfactory wound healing and may cause allergic contact dermatitis.
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Affiliation(s)
- Zoe D Draelos
- Department of Dermatology, Duke University School of Medicine, Durham, NC 27262, USA.
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Algorithm for the management of antibiotic prophylaxis in onychocryptosis surgery. Foot (Edinb) 2010; 20:140-5. [PMID: 20961749 DOI: 10.1016/j.foot.2010.09.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Revised: 09/16/2010] [Accepted: 09/17/2010] [Indexed: 02/04/2023]
Abstract
BACKGROUND Antibiotic prophylaxis in nail surgery is not clearly established, and there is scant scientific evidence regarding the need for its use in preventing surgical site infection, hematogenous total joint infection, and infective endocarditis. OBJECTIVES To propose an algorithm based on the evidence for the management of antibiotic prophylaxis in onychocryptosis surgery. METHODS A literature review was performed in Medline, Pubmed, Cochrane database and Scopus and recent prospective studies were examined. The most-current authoritative guidelines together with new classification system of the pathology have been taken into account. RESULTS In non-risk patients with onychocryptosis stage II or III phenol technique can be used without the need for antibiotics. In stages IV and V, specific antibiotic treatment should be administered before surgery together with partial ablation of nail until the infection is resolved and the process remits to stage II or III. In the case of long-developing onychocryptosis, osteomyelitis should be ruled out, and specific antibiotic treatment besides the preoperative dose should be administered. In high-risk cardiac patients with infective onychocryptosis, the need for prophylaxis for bacterial endocarditis should be considered. CONCLUSION Current evidence does not support the use of preoperative antibiotic prophylaxis in onychocrytosis surgery except in special patients with infective onychocryptosis.
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Shurman DL, Benedetto AV. Antimicrobials in dermatologic surgery: Facts and controversies. Clin Dermatol 2010; 28:505-10. [DOI: 10.1016/j.clindermatol.2010.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Prospective study of wound infections in Mohs micrographic surgery using clean surgical technique in the absence of prophylactic antibiotics. J Am Acad Dermatol 2010; 63:842-51. [PMID: 20800320 DOI: 10.1016/j.jaad.2010.07.029] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 05/16/2010] [Accepted: 07/14/2010] [Indexed: 11/24/2022]
Abstract
BACKGROUND Mohs micrographic surgery (MMS) has a low rate of surgical site infection (SSI) without the use of prophylactic antibiotics. In the studies to date, there has been variation in the steps taken by each surgeon to prevent SSIs but in all cases sterile technique was used during wound reconstruction. OBJECTIVE We sought to evaluate the rate of SSIs among patients undergoing MMS with the use of clean surgical technique for all steps of MMS including wound reconstruction in the absence of prophylactic antibiotics. METHODS We prospectively evaluated 1000 patients undergoing MMS using clean surgical technique for SSIs. Clean surgical technique includes the use of clean surgical gloves and towels and a single pack of sterile instruments for all steps including wound reconstruction. RESULTS There were 11 SSIs among 1000 patients with 1204 tumors, with an overall rate of infection of 0.91% (95% confidence interval 0.38%-1.45%). Three of the 11 infections were complications of hematomas. Four of the 11 infections occurred in flap closures, which had the highest rate of SSIs of 2.67% (4/150). LIMITATIONS The study was a prospective, single-institution uncontrolled study. CONCLUSION To our knowledge, this is the first study to examine the rate of SSIs with the use of clean surgical technique, in the absence of antibiotic prophylaxis, for all steps of MMS including wound reconstruction. Our rate of SSIs of 0.91% is exceedingly low, underscoring the overall safety of MMS and its performance in the outpatient setting without the use of antibiotic prophylaxis or sterile technique.
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Rosengren H, Dixon A. Antibacterial prophylaxis in dermatologic surgery: an evidence-based review. Am J Clin Dermatol 2010; 11:35-44. [PMID: 20000873 DOI: 10.2165/11311090-000000000-00000] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Clean, non-contaminated skin surgery is associated with low rates of surgical site infection (SSI), bacterial endocarditis, and joint prosthesis infection. Hence, antibacterial prophylaxis, which may be associated with adverse effects, the emergence of multidrug-resistant pathogens, and anaphylaxis, is generally not recommended in dermatologic surgery. Some body sites and surgical reconstructive procedures are associated with higher infection rates, and guidelines for SSI antibacterial prophylaxis have been proposed for these cases. Large prospective, controlled trials are needed to ascertain the role of oral SSI prophylaxis for these surgical sites and procedures especially in patients with diabetes mellitus who are intrinsically at greater risk of SSI. Topical antibacterial ointment and sterile paraffin appear to make no difference to healing or the incidence of SSIs in clean wounds. Although further research is needed, preliminary studies have shown that intraincisional antibacterials, which may be associated with fewer adverse effects and a lower risk of multidrug-resistant bacteria, could potentially be helpful for SSI prophylaxis. Trials using honey- and silver-impregnated dressings have found no advantage in the healing of chronic wounds. However, several case studies, which need corroboration in larger studies, suggest that these dressings may be helpful in preventing and treating SSIs. Bacterial endocarditis and joint prosthesis infection prophylaxis are not routinely recommended in cutaneous surgery. The updated 2007 American Heart Association guidelines now advocate bacterial endocarditis prophylaxis for high-risk cardiac patients having surgery involving the oral mucosa or infected skin. The latest American Dental Association/American Academy of Orthopaedic Surgery guidelines recommend considering antibacterial prophylaxis for oral procedures where bleeding is anticipated and for surgery involving acute orofacial skin infections if the patient has had a total joint replacement within 2 years or is in a high-risk group and has had a joint replacement at any time.
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Complications in Dermatologic Surgery. ACTAS DERMO-SIFILIOGRAFICAS 2009. [DOI: 10.1016/s1578-2190(09)70148-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Fratesi L, Weatherhead L. Antibiotic Prophylaxis in Dermatologic Surgery: Is this Supported by Evidence? J Cutan Med Surg 2009; 13:119-20. [DOI: 10.2310/7750.2008.08037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Lauren Fratesi
- Division of Dermatology, University of Ottawa, Ottawa, ON
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Chan BCY, Patel DC. Perioperative management and the associated rate of adverse events in dermatological procedures performed by dermatologists in New Zealand. Australas J Dermatol 2009; 50:23-8. [PMID: 19178488 DOI: 10.1111/j.1440-0960.2008.00498.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Dermatological surgery performed in an outpatient setting is common and generally perceived as safe, but the potential for serious adverse events does exist. Furthermore, there is a current lack of guidelines regarding preoperative and intraoperative monitoring of such patients. This is a retrospective study that involved a written questionnaire sent to current practising New Zealand dermatologists. Aspects investigated include their practice relating to preoperative assessments and intraoperative monitoring during standard dermatological procedures, and the resulting rate of adverse events. We found that most respondents performed dermatological procedures in dedicated theatres in outpatient clinics. The majority of survey respondents would screen for and optimize risk factors prior to surgery. Most respondents would not record vital sign measurements either preoperatively or intraoperatively. Antibiotic prophylaxis was generally only prescribed if clinically indicated, and anticoagulation and antiplatelet therapies were in the majority of cases never withheld prior to surgery. Infection (<3.5%) and bleeding (<2%) were the most common postoperative complications, with other serious adverse events being extremely rare. Although dermatological surgery continues to be safely performed in the outpatient setting, attempts should still be made to identify patients who are at higher risk for surgery and extra precautions should be applied to these selected patients.
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Affiliation(s)
- Bob C Y Chan
- Department of Dermatology, Greenlane Clinical Centre, Auckland City Hospital, Auckland, New Zealand
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Heal CF, Buettner PG, Cruickshank R, Graham D, Browning S, Pendergast J, Drobetz H, Gluer R, Lisec C. Does single application of topical chloramphenicol to high risk sutured wounds reduce incidence of wound infection after minor surgery? Prospective randomised placebo controlled double blind trial. BMJ 2009; 338:a2812. [PMID: 19147639 PMCID: PMC2628297 DOI: 10.1136/bmj.a2812] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine the effectiveness of a single application of topical chloramphenicol ointment in preventing wound infection after minor dermatological surgery. DESIGN Prospective randomised placebo controlled double blind multicentre trial. SETTING Primary care in a regional centre in Queensland, Australia. PARTICIPANTS 972 minor surgery patients. INTERVENTIONS A single topical dose of chloramphenicol (n=488) or paraffin ointment (n=484; placebo). MAIN OUTCOME MEASURE Incidence of infection. RESULTS The incidence of infection in the chloramphenicol group (6.6%; 95% confidence interval 4.9 to 8.8) was significantly lower than that in the control group (11.0%; 7.9 to 15.1) (P=0.010). The absolute reduction in infection rate was 4.4%, the relative reduction was 40%, and the relative risk of wound infection in the control group was 1.7 (95% confidence interval 1.1 to 2.5) times higher than in the intervention group. The number needed to treat was 22.8. CONCLUSION Application of a single dose of topical chloramphenicol to high risk sutured wounds after minor surgery produces a moderate absolute reduction in infection rate that is statistically but not clinically significant. Trial registration Current Controlled Trials ISRCTN73223053.
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Affiliation(s)
- Clare F Heal
- James Cook University, School of Medicine, Mackay Base Hospital, Queensland 4740, Australia.
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33
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Mohs micrographic surgery. Dermatol Surg 2009. [DOI: 10.1016/b978-0-7020-3049-9.00016-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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34
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Yuste M, Romo A, de Unamuno P. Profilaxis antibiótica en cirugía dermatológica. ACTAS DERMO-SIFILIOGRAFICAS 2008. [DOI: 10.1016/s0001-7310(08)76172-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Is Levofloxacin Necessary to Prevent Postoperative Infections of Auricular Second-Intention Wounds? Dermatol Surg 2008. [DOI: 10.1097/00042728-200801000-00005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chronic Wounds of the Lower Extremity: A Preliminary Performance Measurement Set. Plast Reconstr Surg 2008; 121:142-174. [DOI: 10.1097/01.prs.0000294969.68930.06] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Antibiotic Prophylaxis in Dermatologic Surgery. ACTAS DERMO-SIFILIOGRAFICAS 2008. [DOI: 10.1016/s1578-2190(08)70344-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Mailler-Savage EA, Neal KW, Godsey T, Adams BB, Gloster HM. Is levofloxacin necessary to prevent postoperative infections of auricular second-intention wounds? Dermatol Surg 2007; 34:26-30; discussion 30-1. [PMID: 18053054 DOI: 10.1111/j.1524-4725.2007.34004.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Surgeons may prescribe oral quinolones after auricular procedures to prevent postoperative infections, especially those caused by Pseudomonas aeruginosa. OBJECTIVE This study compares the efficacy of levofloxacin and local wound care to local wound care alone in preventing postoperative infection of auricular second-intention wounds. MATERIALS AND METHODS This study was a prospective, randomized trial of 84 consecutive patients (82 in the final analysis) who underwent Mohs micrographic surgery for an auricular neoplasm and had a wound left to heal by second intention. After surgery, patients were randomly assigned to receive either local wound care or local wound care with concurrent 500 mg of levofloxacin by mouth daily. RESULTS Overall, 85.4% of patients had no complications. Complications included 12.2% of patients with inflammatory chondritis and 2.4% of patients with infection. No infections with P. aeruginosa were observed. No statistical significance was observed between the two treatment groups. CONCLUSION Levofloxacin is not necessary to prevent postoperative infections of auricular second-intention wounds after Mohs surgery.
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Affiliation(s)
- Erica A Mailler-Savage
- Department of Dermatology, College of Medicine, University of Cincinnati, Cincinnati, Ohio 45207, USA
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Hurst EA, Grekin RC, Yu SS, Neuhaus IM. Infectious Complications and Antibiotic Use in Dermatologic Surgery. ACTA ACUST UNITED AC 2007; 26:47-53. [PMID: 17349563 DOI: 10.1016/j.sder.2006.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Infection rates in dermatologic surgery are low, ranging on average from 1 to 3%. Studies have shown that many practitioners likely overuse antibiotics, both for prevention of wound infection and in endocarditis prophylaxis. This article discusses patient and environmental risk factors in would infection. Data on wound infection prophylaxis are reviewed, and specific guidelines set forth with regards to appropriate antibiotic usage, drug selection, dosage, and timing. In addition, recommendations surrounding endocarditis and prosthetic joint infection prophylaxis are presented as they apply to dermatologic surgery.
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Affiliation(s)
- Eva A Hurst
- UCSF Dermatologic Surgery and Laser Center, San Francisco, CA 94115, USA
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40
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Rogues AM, Lasheras A, Amici JM, Guillot P, Beylot C, Taïeb A, Gachie JP. Infection control practices and infectious complications in dermatological surgery. J Hosp Infect 2007; 65:258-63. [PMID: 17244515 DOI: 10.1016/j.jhin.2006.09.030] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2006] [Accepted: 09/15/2006] [Indexed: 11/25/2022]
Abstract
The aim of this study was to assess infection control practices and their impact upon infectious complications in skin surgery conducted by private dermatologists. A prospective study was carried out by 73 volunteers belonging to the Surgical Group of the Société Française de Dermatologie over a period of three months. Data were collected for surgical procedures performed during this period, including the excision of all benign or malignant tumours, but excluding sebaceous cysts and pyodermas. A total of 3491 dermatological surgical procedures were included in the survey. Post-operative infections occurred in 67 patients (1.9%), with superficial suppuration accounting for 92.5% of surgical site infections. The incidence was higher in the excision group with a reconstructive procedure (4.3%) than in excisions alone (1.6%). Infection control precautions varied according to the site of procedure; multivariate analysis showed that haemorrhagic complications were an independent factor for infection in both types of surgical procedure. The male gender, immunosuppressive therapy and not wearing sterile gloves were independent factors for infections occurring following excisions with reconstruction. Not all of the procedures needed the use of a hospital theatre. It is clear that for excisions with a reconstructive procedure or for certain anatomical sites, such as the nose, there should be more emphasis upon infection control precautions. Further studies are needed to establish optimal guidelines for this kind of surgery.
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Affiliation(s)
- A M Rogues
- Unité INSERM 657, Université Victor Segalen Bordeaux 2, Bordeaux, France.
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Heal C, Buettner P, Browning S. Risk factors for wound infection after minor surgery in general practice. Med J Aust 2006; 185:255-8. [PMID: 16948620 DOI: 10.5694/j.1326-5377.2006.tb00555.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2006] [Accepted: 07/18/2006] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the incidence of and risk factors for surgical site infections in general practice. DESIGN Prospective, observational study of patients presenting for minor excisions. SETTING Primary care in a regional centre, Queensland, October 2004 to May 2005. PARTICIPANTS 857 patients were assessed for infection. RESULTS The overall incidence of infection was 8.6% (95% CI, 3.5%-13.8%). Excisions from lower legs and feet (P = 0.009) or thighs (P = 0.005), excisions of basal cell carcinoma (P = 0.006) or squamous cell carcinoma (P = 0.002), and diabetes (P < 0.001) were independent risk factors for wound infection. CONCLUSION Our results indicate the high-risk groups for surgery in a general practice setting, such as people with diabetes and those undergoing excision of a non-melanocytic skin cancer or excision from a lower limb. Recognition of these groups could encourage more judicial use of prophylactic antibiotics and use of other interventions aimed at reducing infection rates.
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Affiliation(s)
- Clare Heal
- James Cook University, Mackay, QLD, Australia.
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