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Prevention and Treatment of Bleeding Complications in Dermatologic Surgery

  • Bryan Sofen
  • Isaac NeuhausEmail author
Chapter

Abstract

In general, the rate of complications in dermatologic surgery is extremely low. A single-center prospective analysis of 1343 cases of Mohs micrographic surgery (MMS) reported an overall complication rate of 1.6% (22/1,343 cases), including wound infection, postoperative hemorrhage, hematoma, wound dehiscence, and flap or graft necrosis (Cook JL, Perone JB. Arch Dermatol 139(2):143–52, 2003) [4]. A recent multicenter, prospective study of 23 centers revealed an even lower complication rate of 0.72% (149/20,821 cases) (Alam M, Ibrahim O, Nodzenski M, Strasswimmer JM, Jiang SI, Cohen JL, et al. JAMA Dermatol 149(12):1378–85, 2013) [2a]. This chapter reviews the available evidence regarding the prevention of bleeding complications of cutaneous surgery. Information regarding treatment options after the bleeding has occurred is discussed elsewhere. Although much of the data will be generated from the collective dermatologic experience with Mohs micrographic surgery, the conclusions drawn will be applicable to standard excisional surgery, as well as other common procedures of the dermatologist and dermatologic surgeon. Not only is perioperative bleeding the most common complication associated with cutaneous surgery, but it is also the subject for which the most robust evidence exists. The decision as to whether or not to discontinue anti-coagulation is important as it is estimated that 35–38% of patients undergoing cutaneous surgery are taking an antithrombotic agent (Callahan S, Goldsberry A, Kim G, Yoo S. Dermatol Surg 38(9):1417–26, 2012) [3a]. It is additionally important to note that complications involving dehiscence, necrosis, poor wound healing, and infection often occur after difficulties with hemostasis.

Keywords

Bleeding Hematoma Anticoagulants Surgery Complication 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.UCSF Dermatologic Surgery and Laser CenterSan FranciscoUSA
  2. 2.Department of DermatologyUniversity of California San Francisco, UCSF Dermatologic Surgery and Laser CenterSan FranciscoUSA

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