Intra-incisional prophylactic antibiotics for dermatologic surgery

To determine the efficacy of intra-incisional antibiotics in decreasing the risk of wound infections in cutaneous surgery.

Prospective, blinded, randomized, placebo-controlled trial conducted during an 8-month period.

A private practice Mohs micrographic surgery referral center.

Seven hundred ninety consecutive patients referred for Mohs surgery or other dermatologic surgery were randomized to receive anesthesia either with study compound or placebo. The 2 groups were equivalent with respect to age and sex distribution and the lesions treated were similar in character. No patients were withdrawn for adverse effects.

Patients received local anesthesia before surgery with either buffered lidocaine hydrochloride or a solution consisting of nafcillin sodium in buffered lidocaine.

All surgical wounds were evaluated in a blinded fashion at the time of suture removal (5-7 days) and scored according to a standardized assessment chart based on erythema, edema, and the presence of purulent discharge.

Seven hundred ninety consecutive patients with 908 surgical wounds were enrolled in this study. A total of 12 wound infections were recorded. Eleven (2.5%) of these occurred in the control group, while only 1 (0.2%) occurred in the nafcillin group. This difference was highly significant (P = .003). Observers were blinded to patient groupings particularly for surgical wound scoring.

This study offers strong supporting data for the use of a single intra-incisional dose of an antibiotic administered immediately before dermatologic surgery. The use of nafcillin and buffered lidocaine solution is inexpensive, safe, convenient, and effective.