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Avoiding Electrocautery: Hemostatic Agents for Perioperative Bleeding in Mohs Micrographic Surgery
George M Jeha1,2, Hannah R Malinosky1, Jacob Beer3
1Louisiana State University Health Sciences Center, New Orleans, Louisiana.
Summary
Topical hemostatic agents effectively reduce bleeding during Mohs surgery, especially for patients on blood thinners. These agents show promise for improving perioperative hemostasis and warrant further study.
Area of Science:
- Dermatologic Surgery
- Surgical Hemostasis
- Pharmacology
Background:
- Bleeding is a common complication in Mohs micrographic surgery.
- Increased use of anticoagulants and antiplatelet agents elevates bleeding risk.
- Need for effective perioperative hemostasis strategies in Mohs surgery.
Purpose of the Study:
- Systematically review literature on topical/local hemostatic agents for Mohs surgery.
- Evaluate efficacy and safety of adjunct hemostatic methods.
- Identify agents that reduce bleeding during and after Mohs procedures.
Main Methods:
- Systematic literature search (PubMed, Scopus, Cochrane, EMBASE) up to March 2024.
- Inclusion of original studies on topical or locally injected hemostatic agents.
- Analysis of 7 studies involving 458 patients.
Main Results:
- Evaluated agents included tranexamic acid, brimonidine gel, hemostatic powders, and microporous polysaccharide materials.
- Agents were generally well-tolerated by patients.
- Observed reductions in both intraoperative and postoperative bleeding.
Conclusions:
- Locally administered hemostatic agents are a promising adjunct for bleeding control in Mohs surgery.
- These agents may be particularly beneficial for high-risk bleeding patients.
- Further large-scale, controlled studies are recommended.
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