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Published on: February 20, 2020
Prospective study of wound infections in Mohs micrographic surgery using clean surgical technique in the absence of
Heather D Rogers1, Edward B Desciak, Rebecca P Marcus
1Madison Skin and Laser Center, Seattle, Washington 98104, USA. hrogers@madisonskin.com
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.
Insights
Mohs micrographic surgery (MMS) using clean technique without antibiotics has a very low surgical site infection (SSI) rate of 0.91%. This demonstrates the safety of MMS in outpatient settings without prophylactic antibiotics.
Area of Science:
- Dermatology
- Surgical Oncology
- Infectious Disease
Background:
- Mohs micrographic surgery (MMS) typically has low surgical site infection (SSI) rates without prophylactic antibiotics.
- Previous studies show variation in SSI prevention methods, though sterile technique is common during wound reconstruction.
Purpose of the Study:
- To evaluate the SSI rate in patients undergoing MMS using a consistent clean surgical technique for all procedural steps, including wound reconstruction.
- To assess the efficacy of clean surgical technique in preventing SSIs in the absence of antibiotic prophylaxis.
Main Methods:
- Prospective evaluation of 1000 patients undergoing MMS.
- Implementation of clean surgical technique, including sterile gloves, towels, and instruments for all MMS stages.
- Monitoring for SSIs throughout the study period.
Main Results:
- An overall SSI rate of 0.91% (11 SSIs in 1000 patients, 1204 tumors) was observed.
- Three infections were associated with hematomas.
- Flap closures exhibited the highest SSI rate at 2.67% (4/150).
Conclusions:
- This study is the first to assess SSIs using clean surgical technique for all MMS steps without antibiotic prophylaxis.
- The low SSI rate of 0.91% highlights the safety and efficacy of MMS.
- The findings support the outpatient performance of MMS without antibiotic prophylaxis or strict sterile technique.