Cooper Medical School of Rowan University, Camden, New Jersey.
Department of Dermatology, Cooper Center for Dermatologic Surgery, Evesham, New Jersey.
Dermatol Surg. 2020 Dec;46(12):1492-1497. doi: 10.1097/DSS.0000000000002409.
There are few studies analyzing the surgical site infection (SSI) rate of second intention wounds after dermatologic surgery, and the results are inconclusive. Yet, the current dogma in dermatologic surgery is that wounds healed by second intention have lower infection rates.
To determine the rate of SSI and associated pathogenic organisms of second intention wounds compared with sutured wounds after skin cancer extirpation.
This was a retrospective cohort study of patients who had either Mohs micrographic surgery or wide local excision (WLE) for skin cancer extirpation between 2012 and 2016. Wounds were stratified by closure type, location, and associated organisms. Infection was diagnosed by a positive wound culture.
The overall infection rate was 3.9%. The infection rate for sutured and second intention wounds was 3.2% and 6.8%, respectively. Second intention wounds were associated with a significantly higher risk of infection compared with sutured wounds (odds ratio = 2.22, 95% confidence interval 1.63-2.99). The lower extremity (LE) had the highest overall infection rate (10.5%). The face had the lowest overall infection rate (2.5%).
Mohs micrographic surgery or WLE performed on the LE or lesions allowed to heal by second intention has an increased risk of SSI.
目前鲜有研究分析皮肤科手术后二期愈合伤口的手术部位感染（SSI）率，且结果尚无定论。然而，皮肤科手术的现行观点认为二期愈合的伤口感染率较低。
与皮肤癌切除术后缝合伤口相比，确定二期愈合伤口的 SSI 发生率及相关病原体。
这是一项回顾性队列研究，纳入了 2012 年至 2016 年间接受 Mohs 显微外科手术或广泛局部切除术（WLE）治疗皮肤癌的患者。根据闭合类型、位置和相关病原体对伤口进行分层。感染通过阳性伤口培养来诊断。
总体感染率为 3.9%。缝合和二期愈合伤口的感染率分别为 3.2%和 6.8%。与缝合伤口相比，二期愈合伤口的感染风险显著更高（比值比=2.22，95%置信区间 1.63-2.99）。下肢（LE）的总体感染率最高（10.5%）。面部的总体感染率最低（2.5%）。
LE 或允许二期愈合的病变行 Mohs 显微外科手术或 WLE 后，SSI 的风险增加。
