Risk for Surgical Site Infection Increased In Lower Extremity Mohs Surgery, Wide Local Excisions

Dermatologic surgery performed on the lower extremities carries with it an increased risk for surgical-site infections (SSIs), according to study results published in the Journal of Drugs in Dermatology.

The investigators sought to examine the clinical characteristics associated with SSIs following Mohs micrographic surgery (MMS) and wide local excisions (WLEs) performed below the knee in a single-center retrospective chart review of patients undergoing those procedures. A total of 271 patients were evaluated (142 women and 129 men); 175 underwent MMS and 96 underwent WLE.

Of these participants, 2.3% (4 of 175) of individuals in the MMS group and 8.3% (8 of 96) of individuals in the WLE group developed an SSI (P =.029). The use of subcuticular sutures and vertical mattress sutures was significantly associated with reduced 30-day infection rates compared with the use of other suture methods (P =.006).

Comparisons of patients receiving prophylactic antibiotics vs patients not taking any antibiotics did not demonstrate any statistically significant difference in infection rates among the participants. Moreover, in the 14-day postoperative window, MMS infection rates trended lower compared with WLE infection rates. Although the use of doxycycline prophylaxis was not associated with a statistically significant lower rate of SSIs, the results did approach significance (P =.061). At 14 days, the infection rate with doxycycline was 0%, whereas infections rates with cephalexin and with no antibiotic prophylaxis were 6.5% and 6.4%, respectively.

A major limitation of this study was that it was conducted at a single site, since bacterial flora and drug resistance patterns are known to vary in different geographic locations and time periods.

The investigators concluded that a prospective randomized study may be warranted in order to compare cephalexin with doxycycline in patients undergoing dermatologic surgery below the knee. Because of their link to lower infection rates, subcuticular or vertical mattress sutures may be preferred when closing wounds in patients who are undergoing dermatologic surgery.

Reference

Bari O, Eilers RE Jr, Rubin AG, Jiang SIB. Clinical characteristics of lower extremity surgical site infections in dermatologic surgery based upon 24-month retrospective review. J Drugs Dermatol. 2018;17(7):766-771.