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Journal of the American Academy of Dermatology
Volume 63, n° 5
pages 842-851 (novembre 2010)
Doi : 10.1016/j.jaad.2010.07.029
Dermatologic Surgery

Prospective study of wound infections in Mohs micrographic surgery using clean surgical technique in the absence of prophylactic antibiotics
 

Heather D. Rogers, MD a, b, , Edward B. Desciak, MD c, d, Rebecca P. Marcus, MD d, Shuang Wang, PhD e, Julian MacKay-Wiggan, MD, MPH d, Yehuda D. Eliezri, MD c, d
a Madison Skin and Laser Center, Seattle, Washington 
b Division of Dermatology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington 
c Dermatologic Center for Skin and Laser Surgery, Pomona, New York 
d Department of Dermatology, Columbia University Medical Center, New York, New York 
e Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, New York 

Reprint requests: Heather D. Rogers, MD, Madison Skin and Laser Center, 1101 Madison, Suite 1490, Seattle, WA 98104.
Abstract
Background

Mohs micrographic surgery (MMS) has a low rate of surgical site infection (SSI) without the use of prophylactic antibiotics. In the studies to date, there has been variation in the steps taken by each surgeon to prevent SSIs but in all cases sterile technique was used during wound reconstruction.

Objective

We sought to evaluate the rate of SSIs among patients undergoing MMS with the use of clean surgical technique for all steps of MMS including wound reconstruction in the absence of prophylactic antibiotics.

Methods

We prospectively evaluated 1000 patients undergoing MMS using clean surgical technique for SSIs. Clean surgical technique includes the use of clean surgical gloves and towels and a single pack of sterile instruments for all steps including wound reconstruction.

Results

There were 11 SSIs among 1000 patients with 1204 tumors, with an overall rate of infection of 0.91% (95% confidence interval 0.38%-1.45%). Three of the 11 infections were complications of hematomas. Four of the 11 infections occurred in flap closures, which had the highest rate of SSIs of 2.67% (4/150).

Limitations

The study was a prospective, single-institution uncontrolled study.

Conclusion

To our knowledge, this is the first study to examine the rate of SSIs with the use of clean surgical technique, in the absence of antibiotic prophylaxis, for all steps of MMS including wound reconstruction. Our rate of SSIs of 0.91% is exceedingly low, underscoring the overall safety of MMS and its performance in the outpatient setting without the use of antibiotic prophylaxis or sterile technique.

The full text of this article is available in PDF format.

Key words : clean surgical technique, Mohs micrographic surgery, surgical site infection

Abbreviations used : MMS, MRSA, OR, SSI, VA



 Funding sources: None.
 Conflicts of interest: None declared.



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