Bari Omar, Eilers Robert E, Rubin Ashley G, Jiang Shang I Brian
J Drugs Dermatol. 2018 Jul 1;17(7):766-771.
Dermatologic surgery performed on the lower extremities has an increased risk for surgical site infections (SSI). Our objective was to evaluate the clinical characteristics associated with SSI following Mohs micrographic surgery (MMS) and wide local excisions (WLE) performed below the knee. We performed a single-center retrospective chart review of patients (n=271) that underwent these procedures. Within 14 days of the lower extremity procedure, four of 175 MMS patients (2.3%) developed SSI compared to eight of 96 WLE patients (8.3%; P=0.029). Subcuticular sutures and vertical mattress sutures as a group were associated with reduced 30-day infection rate when compared to other suture methods (P=0.006). Comparison of patients on prophylactic antibiotics to control patients without antibiotics did not reveal a statistically significant difference in infection rate. MMS infection rates trended lower as compared to WLE in the 14-day post-operative window. Doxycycline prophylaxis did not produce a statistically significantly lower rate of SSI, though results approached significance. A prospective study may be warranted to further compare cephalexin and doxycycline for dermatologic surgery below the knee. Subcuticular or vertical mattress sutures may be preferred when closing wounds due to their association with reduced infection rate. J Drugs Dermatol. 2018;17(7):766-771.
下肢进行的皮肤科手术发生手术部位感染（SSI）的风险增加。我们的目的是评估膝关节以下进行Mohs显微外科手术（MMS）和广泛局部切除（WLE）后与SSI相关的临床特征。我们对接受这些手术的患者（n = 271）进行了单中心回顾性病历审查。在下肢手术后14天内，175例MMS患者中有4例（2.3%）发生SSI，而96例WLE患者中有8例（8.3%；P = 0.029）。与其他缝合方法相比，皮下缝合和垂直褥式缝合作为一组与30天感染率降低相关（P = 0.006）。将接受预防性抗生素治疗的患者与未使用抗生素的对照患者进行比较，未发现感染率有统计学上的显著差异。在术后14天内，MMS感染率与WLE相比呈下降趋势。强力霉素预防并未使SSI发生率在统计学上显著降低，尽管结果接近显著水平。可能有必要进行一项前瞻性研究，以进一步比较头孢氨苄和强力霉素用于膝关节以下皮肤科手术的效果。由于皮下或垂直褥式缝合与感染率降低相关，在伤口闭合时可能更受青睐。《皮肤药物学杂志》。2018年；17（7）：766 - 771。
