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Standard practices for cutaneous surgery

Anticoagulant medication should be continued during cutaneous surgery, if considered medically necessary, according to an effort to close practice gaps in cutaneous surgery.

In a recent article in JAMA Facial Plastic Surgery, researchers identified 73 peer-reviewed publications about cutaneous surgery, Mohs micrographic surgery and plastic surgery, from 2000 to 2016, by searching PubMed/MEDLINE. Bibliographies from these references, plus meta-analyses, were also taken into account.

“We hope this article, which summarizes the newest literature in cutaneous surgery, will help guide cutaneous surgeons in their practices and increase patient safety, outcomes and satisfaction,” says co-author Kathryn Kreicher, who in May is graduating from Case Western Reserve University School of Medicine in Cleveland, OH, and will be a resident in otolaryngology-head and neck surgery at the University of Connecticut beginning July 2017.

According to Dr. Kreicher, principal author Jeremy Bordeaux, M.D., director of Mohs Micrographic and Dermatologic Surgery at University Hospitals Cleveland Medical Center found through discussions with colleagues “that dermatologists and other surgeons who perform cutaneous surgery have different standard practices for their patients preoperatively, intraoperatively and postoperatively. For example, surgeons differ on whether to continue anticoagulation, what type of anxiolysis to use and whether to prescribe opioids for postsurgical pain.”

Besides the review pointing out that anticoagulant and antiplatelet medication should be continued during surgery, “Anxiety is best addressed with music or anxiolytic drugs, and postoperative pain can generally be managed without opioid medications,” Dr. Kreicher says.    

Unexpectedly, authors also found in their review that topical antibiotics do not reduce postoperative wound infections. “In fact, these ointments are more costly and are more likely to cause allergic contact dermatitis, and thus we recommend using an alternative such as white petrolatum for wound care,” Dr. Kreicher says.

NEXT: The ‘Standard Practice’ Checklist

 

The ‘Standard Practice’ Checklist

This list summarizes the review findings to enhance efficacy, patient safety and comfort when performing large cutaneous surgical resections under local anesthesia:

  • Music and anxiolytics reduce patient anxiety, prevent cardiovascular compromise and improve patient satisfaction.

  • Anticoagulant and antiplatelet medication should continue during cutaneous surgery, if deemed medically necessary.

  • Surgeons and support staff should carefully consider the dose and injection angle of local anesthetic.

  • Postoperative opioids and topical antibiotics should be avoided, as they can cause harm to patients.

  • Acetaminophen and ibuprofen provide adequate pain control with fewer adverse effects than opioid medications.

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