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Surgical Site Infection After Dermatologic Procedures: Critical Reassessment of Risk Factors and Reappraisal of Rates and Causes

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Abstract

While rates are low, surgical site infections are the most common complication of dermatologic surgery. Surgical site infections have important consequences including impairment of wound healing, suboptimal cosmetic outcome, hospitalization, increased healthcare costs, and rarely, systemic infection. It is imperative to understand the risk factors and existing preventative measures to minimize the development of infection. This article reviews the available literature regarding surgical site infections following dermatologic procedures, to evaluate the standard of diagnosis and role of wound culture, risk factors, mimicking conditions, and significance of antibiotic prophylaxis. We offer a critical reassessment of the current literature on risk factors and reappraisal of infection rates to promote evidence-based patient care. We conclude that the strongest evidence suggests that diabetes mellitus is likely associated with increased surgical site infections. Immunosuppression is often clinically considered a risk factor; however, the evidence is mixed. In general the addition of antibiotics does not confer benefit except in high-risk sites. Conclusively, Mohs micrographic surgery has been proven safe in office and inpatient settings. We agree that sterile glove use for simple procedures is likely not a significant factor in the development of surgical site infections; however, we hypothesize that the overall sterile technique and setting may play a role in longer and/or more complex procedures.

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Authors and Affiliations

  1. School of Medicine and Health Sciences, George Washington University School of Medicine and Health Sciences, Washington, DC, USA

    Gabrielle Schwartzman

  2. Department of Dermatology, State University of New York Downstate, Veterans Affairs Medical Center, 800 Poly Place, Brooklyn, NY, 11209, USA

    Amor Khachemoune

  3. Department of Dermatology, Veterans Health Administration, Brooklyn, NY, USA

    Amor Khachemoune

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Correspondence to Amor Khachemoune.

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AK had the idea for the article. GS performed the initial literature search and data analysis and drafted the initial draft. GS and AK revised the work.

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Schwartzman, G., Khachemoune, A. Surgical Site Infection After Dermatologic Procedures: Critical Reassessment of Risk Factors and Reappraisal of Rates and Causes. Am J Clin Dermatol 22, 503–510 (2021). https://doi.org/10.1007/s40257-021-00599-3

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