Related Experiment Video
Updated: May 30, 2026
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Prospective evaluation of dermatologic surgery complications including patients on multiple antiplatelet and
Jeremy S Bordeaux1, Kathryn J Martires2, Dori Goldberg3
1Department of Dermatology, University Hospitals Case Medical Center, Cleveland, Ohio; Case Western Reserve University School of Medicine, Cleveland, Ohio.
Background:
Few prospective studies have evaluated the safety of dermatologic surgery.
Objective:
We sought to determine rates of bleeding, infection, flap and graft necrosis, and dehiscence in outpatient dermatologic surgery, and to examine their relationship to type of repair, anatomic location of repair, antibiotic use, antiplatelet use, or anticoagulant use.
Methods:
Patients presenting to University of Massachusetts Medical School Dermatology Clinic for surgery during a 15-month period were prospectively entered. Medications, procedures, and complications were recorded.
Results:
Of the 1911 patients, 38% were on one anticoagulant or antiplatelet medication, and 8.0% were on two or more. Risk of hemorrhage was 0.89%. Complex repair (odds ratio [OR] = 5.80), graft repair (OR = 7.58), flap repair (OR = 11.93), and partial repair (OR = 43.13) were more likely to result in bleeding than intermediate repair. Patients on both clopidogrel and warfarin were 40 times more likely to have bleeding complications than all others (P = .03). Risk of infection was 1.3%, but was greater than 3% on the genitalia, scalp, back, and leg. Partial flap necrosis occurred in 1.7% of flaps, and partial graft necrosis occurred in 8.6% of grafts. Partial graft necrosis occurred in 20% of grafts on the scalp and 10% of grafts on the nose. All complications resolved without sequelae.
Limitations:
The study was limited to one academic dermatology practice.
Conclusion:
The rate of complications in dermatologic surgery is low, even when multiple oral anticoagulant and antiplatelet medications are continued, and prophylactic antibiotics are not used. Closure type and use of warfarin or clopidogrel increase bleeding risk. However, these medications should be continued to avoid adverse thrombotic events.
Insights
Dermatologic surgery has a low complication rate, even with continued anticoagulant and antiplatelet medications. Closure type and specific medications like warfarin or clopidogrel increase bleeding risk but should be continued to prevent thrombotic events.
Area of Science:
- Dermatologic surgery safety
- Surgical complication rates
Background:
- Limited prospective data exists on dermatologic surgery safety.
- Understanding complication rates is crucial for patient care.
Purpose of the Study:
- To determine the incidence of bleeding, infection, necrosis, and dehiscence in outpatient dermatologic surgery.
- To analyze the impact of repair type, location, and medication use on these complications.
Main Methods:
- Prospective study of 1911 patients at a dermatology clinic over 15 months.
- Detailed recording of patient medications, surgical procedures, and post-operative complications.
Main Results:
- Hemorrhage risk was 0.89%; complex repairs, grafts, flaps, and partial repairs increased bleeding risk.
- Infection risk was 1.3%, higher on genitalia, scalp, back, and leg.
- Graft necrosis occurred in 8.6% of grafts, particularly on the scalp (20%) and nose (10%).
Conclusions:
- Dermatologic surgery exhibits a low complication rate, even with continued anticoagulant/antiplatelet therapy and no prophylactic antibiotics.
- Warfarin or clopidogrel use and specific closure types elevate bleeding risk.
- Continuing these medications is recommended to mitigate thrombotic event risks.
Related Concept Videos
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
01:30Venous Thrombosis IV: Nursing Management
01:29Venous Thrombosis III: Interprofessional Care
01:22Aneurysm IV: Nursing Management
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management