Arguello-Guerra Lilia, Vargas-Chandomid Estefanía, Díaz-González Jose Manuel, Méndez-Flores Silvia, Ruelas-Villavicencio Ana, Domínguez-Cherit Judith
Dermatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Mexico City. Mexico.
Cir Cir. 2019;86(1):15-23. doi: 10.24875/CIRUE.M18000003.
Surgery is performed more frequently now at days, due to the increasing incidence of melanoma and no-melanoma skin cancer. There are different opinions among dermatologic surgeons between to continue or discontinue antithrombotic therapy prior to the procedure, which increases the risk of thromboembolic events. Prophylaxis with oral antibiotics in the postsurgical period is controversial.
To report the safety of surgery without suspending antithrombotic therapy and without oral antibiotic prophylaxis in dermatology surgery of patients with multiple comorbidities and polypharmacy.
We designed a retrospective study. We included a total of 655 patients; 96.6% had at least one comorbidity; 27.7% used aspirin and 4.3% some type of antithrombotic therapy. The most common type of skin tumor was basal cell carcinoma with 69.8.
The complication rate was 4.2%; the most was wound dehiscence (1.1%), followed by partial necrosis (0.9%), infection (0.9%), reaction to foreign body (0.6%), complete necrosis (0.3%), bleeding (0.2%) and fistulae (0.2%).
Based on the literature and our experience, dermatologic surgery is safe without suspending antithrombotic therapy or antibiotic prophylaxis in patients with multiple comorbidity.
如今，由于黑色素瘤和非黑色素瘤皮肤癌的发病率不断上升，手术的实施频率更高。在手术前继续或停止抗血栓治疗在皮肤科外科医生中存在不同意见，因为这会增加血栓栓塞事件的风险。术后口服抗生素预防存在争议。
报告在患有多种合并症和使用多种药物的患者进行皮肤科手术时，不暂停抗血栓治疗且不进行口服抗生素预防的手术安全性。
我们设计了一项回顾性研究。我们共纳入655例患者；96.6%至少有一种合并症；27.7%使用阿司匹林，4.3%使用某种类型的抗血栓治疗。最常见的皮肤肿瘤类型是基底细胞癌，占69.8%。
并发症发生率为4.2%；最常见的是伤口裂开（1.1%），其次是部分坏死（0.9%）、感染（0.9%）、异物反应（0.6%）、完全坏死（0.3%）、出血（0.2%）和瘘管（0.2%）。
基于文献和我们的经验，在患有多种合并症的患者中，皮肤科手术在不暂停抗血栓治疗或抗生素预防的情况下是安全的。
