Topical Hemostatic-Anesthetic Solution to Reduce Bleeding During Mohs Micrographic Surgery: A Case Control Study

Area of Science:

• Dermatology
• Surgical Oncology
• Pharmacology

Background:

• Mohs micrographic surgery involves waiting periods between stages for histopathological analysis.
• Wound management between stages typically includes dressing and patient observation.
• Minimizing bleeding during these intervals is crucial for patient comfort and surgical efficiency.

Purpose of the Study:

• To evaluate the effectiveness of a hemostatic-anesthetic solution-impregnated gauze in controlling inter-stage bleeding in Mohs surgery.
• To compare bleeding levels between patients treated with the TAL solution and a saline control group.

Main Methods:

• A randomized controlled trial involving 40 patients undergoing Mohs surgery.
• Twenty patients received gauze impregnated with tranexamic acid, adrenaline, and lidocaine (TAL).
• Twenty patients received saline-impregnated gauze as a control.
• Bleeding was quantified by measuring blood stain size relative to the surgical defect size.
• Rotation Thromboelastometry (ROTEM) assessed the impact of lidocaine and adrenaline on tranexamic acid-induced clot stability.

Main Results:

• The TAL-treated group showed a significantly lower blood stain to defect size ratio (1:1.47) compared to the control group (1:3.37, P < .001).
• ROTEM analysis confirmed that lidocaine and adrenaline did not impede the pro-coagulant effects of tranexamic acid.
• The hemostatic-anesthetic solution effectively reduced inter-stage bleeding without compromising clot function.

Conclusions:

• Impregnated gauze with tranexamic acid, adrenaline, and lidocaine is an effective method for reducing bleeding between Mohs surgery stages.
• This topical application offers a safe and efficient adjunct for managing surgical wounds during Mohs procedures.
• The findings suggest a potential improvement in patient experience and surgical workflow in Mohs surgery.