scholarly journals Newer Hemostatic Agents Used in the Practice of Dermatologic Surgery

2013 ◽  
Vol 2013 ◽  
pp. 1-15 ◽  
Author(s):  
Jill Henley ◽  
Jerry D. Brewer
Keyword(s):  
Wound Care ◽  
Postoperative Bleeding ◽  
Wound Dehiscence ◽  
Bleeding Complications ◽  
Dermatologic Surgery ◽  
Bleeding Diathesis ◽  
Hemostatic Agents ◽  
Hematoma Formation ◽  
Poor Outcomes ◽  
Risk For Bleeding

Minor postoperative bleeding is the most common complication of cutaneous surgery. Because of the commonality of this complication, hemostasis is an important concept to address when considering dermatologic procedures. Patients that have a bleeding diathesis, an inherited/acquired coagulopathy, or who are on anticoagulant/antiplatelet medications pose a greater risk for bleeding complications during the postoperative period. Knowledge of these conditions preoperatively is of the utmost importance, allowing for proper preparation and prevention. Also, it is important to be aware of the various hemostatic modalities available, including electrocoagulation, which is among the most effective and widely used techniques. Prompt recognition of hematoma formation and knowledge of postoperative wound care can prevent further complications such as wound dehiscence, infection, or skin-graft necrosis, minimizing poor outcomes.

Surgical wound dehiscence in dermatologic surgery.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e22101-e22101
Author(s):  
Tanner Harding ◽  
Jennifer Seyffert ◽  
Brittany Maner ◽  
Nathan Bibliowicz ◽  
Asmi Sanghvi ◽  
...  
Keyword(s):  
Postoperative Infection ◽  
Postoperative Bleeding ◽  
Wound Dehiscence ◽  
Smoking History ◽  
Dermatologic Surgery ◽  
Surgical Wound ◽  
Provider Type ◽  
Factors Associated ◽  
Surgical Wound Dehiscence ◽  
Healing Wound

e22101 Background: Surgical wound dehiscence (SWD) describes separation of wound edges due to mechanical failure of a healing wound. The rate of SWD following dermatology office-based surgery and factors associated with its occurrence are poorly characterized in the current literature. This study aims to elucidate factors contributing to SWD following cutaneous excisions of malignant and non-malignant through a novel data mining methodology. The utility of this methodology in quality assurance and risk management applications will be concomitantly explored. Methods: An electronic query directed at the electronic medical record (EMR) database of a large national dermatology practice employing over 400 providers yielded 22,548 instances of cutaneous excision meeting inclusion criteria between 1 January 2018 and 9 September 2019. To control for confounding, procedures positive for SWD were randomly matched in 1:4 ratio with procedures negative for SWD on the basis of sex, age, and precise anatomic location. Procedures were then statistically analyzed to elucidate factors associated with SWD. Results: Of 22,548 procedures analyzed, 123 were positive for wound dehiscence, yielding an incidence of 0.54%. Age ( Χ2 ( df = 1, N = 615) = 2.49, p = 0.039), smoking history ( Χ2 ( df = 2, N = 534) = 9.97, p = 0.007), wound location on the distal extremities ( Χ2 ( df = 1, N = 615) = 9.54, p = 0.002), presence of postoperative infection ( Χ2 ( df = 1, N = 600) = 34.87, p < 0.001), and presence of postoperative bleeding ( Χ2 ( df = 1, N = 600) = 62.73, p < 0.001) are all significantly associated with SWD. A wound positive for postoperative infection or bleeding has 14.48 times the odds of being positive for SWD (95% CI: 4.62 - 45.21). A wound positive for postoperative bleeding has 20.15 times the odds of being positive for SWD (95% CI: 7.42 – 54.73). No significant relationship between SWD and sex, diabetes, or provider type is evident. Conclusions: Age, smoking history, wound location on the distal extremities, and especially other postoperative complications such as bleeding and infection are associated with SWD. There is no association between SWD and sex, diabetes, or provider type. Forthcoming multifactorial, nonlinear, non-time-dependent analysis of variables may allow for the development of a statistical model to provide greater insight into SWD following dermatologic surgery.

scholarly journals Increased Postoperative Bleeding Risk among Patients with Local Flap Surgery under Continued Clopidogrel Therapy

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Wolfgang Eichhorn ◽  
Martina Haase ◽  
Lan Kluwe ◽  
Jürgen Zeuch ◽  
Ralf Smeets ◽  
...  
Keyword(s):  
Antiplatelet Therapy ◽  
Univariate Analysis ◽  
Postoperative Bleeding ◽  
Tumor Resection ◽  
Bleeding Risk ◽  
Skin Tumor ◽  
Bleeding Complications ◽  
Skin Grafts ◽  
Clopidogrel Therapy ◽  
Study Population

Purpose. The purpose of the study was to evaluate the influence of a continued antiplatelet therapy with clopidogrel on postoperative bleeding risk in patients undergoing skin tumor resection and reconstruction with local flaps or skin grafts under outpatient conditions.Patients and Methods. The authors designed and implemented a retrospective clinical cohort study at the General Hospital Balingen. The primary endpoint was the bleeding ratio in patients with clopidogrel treatment in comparison to patients without any anticoagulant or antiplatelet therapy. Wound healing was evaluated on days 1, 3, 5, 7, 10, and 14.Results. 650 procedures were performed, 123 of them under continued clopidogrel therapy. There were significantly more postoperative bleeding complications among patients with continued antiplatelet therapy. Regarding the whole study population, malignant lesions, a larger defect size, and skin grafts were accompanied by a higher rate of bleeding incidents. However, there were no significant findings in the univariate analysis of the clopidogrel group. All bleeding incidents were easily manageable.Conclusion. Despite an increased bleeding ratio among patients under continued clopidogrel therapy, the performance of simple surgical procedures can be recommended. However, cautious preparation and careful hemostasis are indispensable.

A Prospective Clinical Evaluation of the Effects of Intraoperative Systemic Anticoagulation in Patients Undergoing Arteriovenous Fistula Surgery

2010 ◽  
Vol 76 (10) ◽  
pp. 1112-1114 ◽  
Author(s):  
Bonnie R. Wang ◽  
Vincent L. Rowe ◽  
Sung Wan Ham ◽  
Sukgu Han ◽  
Kaushal Patel ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Postoperative Bleeding ◽  
Bleeding Complications ◽  
Controlled Study ◽  
Control Group ◽  
Heparin Group ◽  
Av Fistula ◽  
Fistula Surgery ◽  
Significant Difference ◽  
The Difference

No standard presently exists for the use of systemic heparin during angioaccess surgery to decrease the incidence of postoperative thrombotic complications. Our objective was to study the effects of intraoperatively administered heparin on 30-day patency and postoperative bleeding complications in patients undergoing autogenous arteriovenous (AV) fistula surgery. A prospective, double-blinded, randomized controlled study was performed on 48 patients undergoing AV fistula creation from April 2007 through November 2009. Of the 48 patients, 22 were randomized to the control group and received no heparin. Twenty-six were randomized to receive heparin (75 units/kg intravenously) before clamping of the artery. There was no significant difference in 30-day patency between the heparin and control groups (92% vs 86%, P = 0.65), respectively. Three patients (12%) developed hematomas in the heparin group compared with one (5%) in the control group; however the difference was not statistically significant ( P = 0.61). The results suggest that intraoperative administration of heparin has no statistically significant effect on 30-day patency rates or postoperative bleeding complications. Larger trials with longer term follow-up and assessment of maturation rates are needed to determine the effect of intraoperative anticoagulation on these outcomes of arteriovenous fistula surgery.

Hematoma after Head and Neck Surgery—A Major Complication?

1978 ◽  
Vol 86 (2) ◽  
pp. ORL-171-ORL-175 ◽  
Author(s):  
Jonas T. Johnson ◽  
Charles W. Cummings
Keyword(s):  
Head And Neck ◽  
Major Complication ◽  
Wound Dehiscence ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Major Infection ◽  
Hematoma Formation ◽  
Postoperative Hematoma ◽  
Clot Evacuation

The role of hematoma formation in the development of complications after major head and neck surgery is surveyed retrospectively. An incidence of 4.2% was encountered. In all cases, the hematoma was identified within 12 hours postoperatively. Prompt surgical clot evacuation and reinstitution of drainage did not adversely affect the patient's subsequent course. Failure to adequately drain the hematoma resulted in increased wound dehiscence, major infection, and fistula. When properly treated, postoperative hematoma formation offers only the risks attendant with a second anesthesia; no subsequent related morbidity need be anticipated.

scholarly journals Bleeding due to acquired dysfibrinogenemia as the initial presentation of multiple myeloma

2019 ◽  
Vol 12 (7) ◽  
pp. e229312
Author(s):  
Namrah Siddiq ◽  
Colin Bergstrom ◽  
Larry D Anderson ◽  
Srikanth Nagalla
Keyword(s):  
Multiple Myeloma ◽  
Activity Level ◽  
Initial Presentation ◽  
Bleeding Complications ◽  
Light Chains ◽  
Bleeding Diathesis ◽  
Antigen Level ◽  
Free Light Chains ◽  
Serum Free ◽  
Serum Free Light Chains

Patients with multiple myeloma (MM) are at risk for acquired dysfibrinogenemia resulting in laboratory abnormalities and/or bleeding complications. We describe a 63-year-old man who presented with bleeding diathesis in the presence of a low fibrinogen activity level with a normal fibrinogen antigen level. Further studies revealed elevated levels of lambda free light chains, and he was diagnosed with MM. Despite initiating treatment with bortezomib/dexamethasone, he continued to have recurrent bleeds along with hypofibrinogenaemia, prompting a switch to carfilzomib/dexamethasone. The patient responded with improvement in bleeding symptoms, normalisation of fibrinogen activity and a decrease in serum free light chains.

Treatment of Pilonidal Disease with Laser Epilation

2006 ◽  
Vol 72 (6) ◽  
pp. 534-537 ◽  
Author(s):  
S.M. Schulze ◽  
N. Patel ◽  
D. Hertzog ◽  
L.G. Fares
Keyword(s):  
Adjunctive Therapy ◽  
Wound Care ◽  
Pilonidal Disease ◽  
Treatment Options ◽  
Wound Dehiscence ◽  
Surgical Excision ◽  
Etiologic Agent ◽  
Laser Treatments ◽  
Superficial Wound ◽  
Laser Epilation

Pilonidal disease is a debilitating, chronic disease of the natal cleft. It mainly involves the sacrococcygeal region and the presentation varies from asymptomatic pits to painful draining abscesses. Treatment options vary from observation to wide excision. Unfortunately, surgical treatment often results in recurrence. The etiologic agent remains in question, as does the optimal treatment. Our objective was to assess the efficacy of laser epilation as an adjunctive therapy to surgical excision of the pilonidal sinus. Eighteen men and five women were treated with laser epilation in our office from 2001 to 2004. All patients had experienced recurrent folliculitis and had undergone some form of drainage procedure or prior excision. After surgical excision of the affected area, a Vasculite™ Plus laser was used for the epilation treatments. Each session involved 9 to 12 treatments and the patients underwent an average of two sessions. All 19 of the patients that remain in follow-up report no recurrence of their folliculitis or need for further surgical procedures. During treatment, six of the men and one of the women experienced a superficial wound dehiscence. All healed with local wound care and continued laser treatments. Laser epilation is an effective adjunctive therapy for the treatment of pilonidal disease. Although not curative in and of itself, the removal of hair allows better healing and decreases the chance of recurrence by removal of a significant etiology of pilonidal disease.

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