Optimizing Surgical Outcomes

  • Thomas Stasko
  • Amy Ross


To optimize outcomes associated with cutaneous procedures the surgeon must consider multiple factors. Many of these factors should be addressed prior to the start of surgery and others require attention during or after the procedure. Recognition of these factors can aid in the meticulous planning and attention to detail necessary to obtain the best outcome following surgical treatment of skin cancer.


International Normalize Ratio Skin Cancer Merkel Cell Carcinoma Chlorhexidine Gluconate Cutaneous Surgery 
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  1. 1.
    Procedure Survey. Dermasurgery Trends and Statistics. Rolling Meadows, IL: American Society for Dermatologic Surgery; 2005. Available from: http://www.asds.net/TheAmericanSocietyforDermatologicSurgeryReleasesNewProcedureSurveyData.aspx. Last accessed February 3, 2009.
  2. 2.
    Kaplan AL, Weitzul SB, Taylor RS. Longitudinal diminution of tumor size for basal cell carcinoma suggests shifting referral patterns for Mohs surgery. Dermatol Surg. 2008;34:15–19.CrossRefPubMedGoogle Scholar
  3. 3.
    Cook J, Zitelli JA. Mohs micrographic surgery: a cost analysis. J Am Acad Dermatol. 1998;39:698–703.CrossRefPubMedGoogle Scholar
  4. 4.
    Kovich O, Otley CC. Perioperative management of anticoagulants and platelet inhibitors for cutaneous surgery: a survey of current practice. Dermatol Surg. 2002;28:513–517.CrossRefPubMedGoogle Scholar
  5. 5.
    Otley CC. Continuation of medically necessary aspirin and warfarin during cutaneous surgery. Mayo Clin Proc. 2003;78:1392–1396.CrossRefPubMedGoogle Scholar
  6. 6.
    Alcalay J, Alkalay R. Controversies in perioperative management of blood thinners in dermatologic surgery: continue or discontinue? Dermatol Surg. 2004;30:1091–1094.CrossRefPubMedGoogle Scholar
  7. 7.
    Schanbacker CF, Bennett RG. Postoperative stroke after stopping warfarin for cutaneous surgery. Dermatol Surg. 2000;26:785–789.CrossRefGoogle Scholar
  8. 8.
    Alam M, Goldberg LH. Serious adverse vascular events associated with perioperative interruption of antiplatelet and anticoagulant therapy. Dermatol Surg. 2002;28992–998.CrossRefPubMedGoogle Scholar
  9. 9.
    Kovich O, Otley CC. Thrombotic complications related to discontinuation of warfarin and aspirin therapy perioperatively for cutaneous operation. J Am Acad Dermatol. 2003;48:233–237.CrossRefPubMedGoogle Scholar
  10. 10.
    Chang LK, Whitaker DC. The impact of herbal medicines on dermatologic surgery. Dermatol Surg. 2001;27:759–763.CrossRefPubMedGoogle Scholar
  11. 11.
    Timbo BB, Ross MP, McCarthy PV, et al. Dietary supplements in a national survey: Prevalence of use and reports of adverse events. J Am Diet Assoc. 2006;106:1966–1974.CrossRefPubMedGoogle Scholar
  12. 12.
    Cox AC, Rao GH, Gerrard JM, White JG. The influence of vitamin E quinone on platelet structure, function, and biochemistry. Blood. 1980;55:907–914.PubMedGoogle Scholar
  13. 13.
    Ziv O, Ragni MV. Bleeding manifestations in males with von Willebrand disease. Haemophilia. 2004;10:162–168.CrossRefPubMedGoogle Scholar
  14. 14.
    Werner EJ, Broxson EH, Tucker EL, et al. Prevalence of von Willebrand disease in children: a multiethnic study. J Pediatr. 1993;123:893–898.CrossRefPubMedGoogle Scholar
  15. 15.
    Leonard AL, Hanke CW, Greist A. Perioperative management of von Willebrand disease in dermatologic surgery. Dermatol Surg. 2007;33:403–409.CrossRefPubMedGoogle Scholar
  16. 16.
    Nichols WC, Ginsburg D. Von Willebrand disease. Medicine (Baltimore ). 1997;76:1–20.CrossRefGoogle Scholar
  17. 17.
    Bailey BJ, Johnson JT, Newlands SD. Head & Neck Surgery—Otolaryngology. Philadelphia: Lippincott Williams & Wilkins; 2006:217.Google Scholar
  18. 18.
    Busti AJ, Hooper JS, Amaya CJ, Kazi S. Effects of perioperative anti-inflammatory and immunomodulating therapy on surgical wound healing. Pharmacotherapy. 2005;25:1566–1591.CrossRefPubMedGoogle Scholar
  19. 19.
    Abdelmalek M, Spencer J. Retinoids and wound healing. Dermatol Surg. 2006;32:1219–1230.CrossRefPubMedGoogle Scholar
  20. 20.
    Taniguchi Y, Shimizu Y, Inachi S, Shimizu M. Skin surgery in patients 90 years of age and over. Int J Dermatol. 1998;37:547–550.CrossRefPubMedGoogle Scholar
  21. 21.
    MacFarlane DF, Pustelny BL, Goldberg LH. An assessment of the suitability of Mohs micrographic surgery in patients aged 90 years and older. Dermatol Surg. 1998;23:389–392.CrossRefGoogle Scholar
  22. 22.
    Berman B, Flores F. The treatment of hypertrophic scars and keloids. Eur J Dermatol. 1998;8:591–595.PubMedGoogle Scholar
  23. 23.
    Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis guidelines from the American Heart Association. Circulation. 2007;116:1736–1754.CrossRefPubMedGoogle Scholar
  24. 24.
    Scher K, Elston DM, Hedrick JA, Joseph WS, Maurer T, Murakawa GJ. Treatment options in the management of uncomplicated skin and skin structure infections. Cutis. 2005;75:3–23.PubMedGoogle Scholar
  25. 25.
    American Academy of Orthopaedic Surgeons Advisory Statement on Antibiotic Prophylaxis for Dental Patients with Total Joint Replacements. http://www.aaos.org/about/papers/advistmt/1027.asp. Last accessed January 21, 2009.
  26. 26.
    Wright TI, Baddour LM, Berbari EF. Antibiotic prophylaxis in dermatologic surgery: advisory statement 2008. J Am Acad Dermatol. 2008;59:464–473.CrossRefPubMedGoogle Scholar
  27. 27.
    Sheridan RL, Schulz JT, Weber JM, et al. Cutaneous herpetic infections complicating burns. Burns. 2000;26:621–624.CrossRefPubMedGoogle Scholar
  28. 28.
    Fidler PE, Mackool BT, Schoenfeld DA, et al. Incidence, outcome, and long-term consequences of herpes simplex virus type 1 reactivation presenting as a facial rash in intubated adult burn patients treated with acyclovir. J Trauma. 2002;53:86–89.CrossRefPubMedGoogle Scholar
  29. 29.
    Verrill PJ. Adverse reactions to local anaesthetics and vasoconstrictor drugs. Practitioner. 1975;214: 380–387.PubMedGoogle Scholar
  30. 30.
    Amsler E, Flahault A, Mathelier-Fusade P, Aractingi S. Evaluation of re-challenge in patients with suspected lidocaine allergy. Dermatology. 2004;208:109–111.CrossRefPubMedGoogle Scholar
  31. 31.
    Dire DJ. Hogan DE. Double-blinded comparison of diphenhydramine versus lidocaine as a local anesthetic. Ann Emerg Med. 1993;22:1419–1422.CrossRefPubMedGoogle Scholar
  32. 32.
    Romano A, Gueant-Rodriguez RM, Viola M, Pettinato R, Gueant JL. Cross-reactivity and tolerability of cephalosporins in patients with immediate hypersensitivity to penicillins. Ann Intern Med. 2004;141:16–22.PubMedGoogle Scholar
  33. 33.
    El-Gamal HM, Dufresne RG, Saddler K. Electrosurgery, pacemakers, and ICDs: a survey of precautions and complications experienced by cutaneous surgeons. Dermatol Surg. 2001;27:385–390.CrossRefPubMedGoogle Scholar
  34. 34.
    Lane JE, O’Brien EM, Kent DE. Optimization of thermocautery in excisional dermatologic surgery. Dermatol Surg. 2006;32:669–675.CrossRefPubMedGoogle Scholar
  35. 35.
    Haines RC Jr, Brooks LR. Office space planning and design for medical practices, Part 1: an overview. J Med Pract Manage. 2003;18:244–249.PubMedGoogle Scholar
  36. 36.
    Haines RC Jr, Griffin JK. Office space planning and design for medical practices: Part 3, Implementation, design, and construction. J Med Pract Manage. 2003;19:19–26.PubMedGoogle Scholar
  37. 37.
    Lutz ME. Surgical pearl: curettage before cutaneous surgery to identify an unidentifiable biopsy site. J Am Acad Dermatol. 2002;46:591–593.CrossRefPubMedGoogle Scholar
  38. 38.
    Robbins P, Sarnoff DS. Where’s the spot? J Dermatol Surg Oncol. 1986;12:1251–1252.Google Scholar
  39. 39.
    Futoryan T, Grande D. Postoperative wound infection rates in dermatologic surgery. Dermatol Surg. 1995;21:509–514.CrossRefPubMedGoogle Scholar
  40. 40.
    Whitaker DC, Grande DJ, Johnson SS. Wound infection rate in dermatologic surgery. J Dermatol Surg Oncol. 1988;14:525–528.PubMedGoogle Scholar
  41. 41.
    Carmichael AJ, Flanagan PG, Holt PJA, Duerden BI. The occurrence of bacteraemia with skin surgery. Br J Dermatol. 1996;134:120–122.CrossRefPubMedGoogle Scholar
  42. 42.
    Mulberry G, Snyder AT, Heilman J, Pyrek J, Stahl J. Evaluation of a waterless, scrubless chlorhexidine gluconate/ethanol surgical scrub for antimicrobial efficacy. Am J Infect Control. 2001;29:377–382.CrossRefGoogle Scholar
  43. 43.
    Gupta C, Czubatyj AM, Briski LE, Malani AK. Comparison of two alcohol-based surgical scrub solutions with an iodine-based scrub brush for presurgical antiseptic effectiveness in a community hospital. J Hosp Infect. 2007;65:65–71.CrossRefPubMedGoogle Scholar
  44. 44.
    Rhinehart BM, Murphy ME, Farley MF, Albertini JG. Sterile versus nonsterile gloves during Mohs micrographic surgery: infection rate is not affected. Dermatol Surg. 2006;32:170–176.CrossRefPubMedGoogle Scholar
  45. 45.
    Kupres K, Rasmussen SE, Albertini JG. Perforation rates for nonsterile examination gloves in routine dermatologic procedures. Dermatol Surg. 2002;28:388–389.CrossRefPubMedGoogle Scholar
  46. 46.
    Gross DJ, Jamison Y, Martin K, Fields M, Dinehart SM. Surgical glove perforation in dermatologic surgery. J Dermatol Surg Oncol. 1989;15:1226–1228.PubMedGoogle Scholar
  47. 47.
    Cohen MD, Do JT, Tahery DP, Moy RL. Efficacy of double gloving as a protection against blood exposure in dermatologic surgery. J Dermatol Surg Oncol. 1992;18:873–874.PubMedGoogle Scholar
  48. 48.
    Eagle KA, Brundage BH, Chaitman BR, et al. Guidelines for perioperative cardiovascular evaluation for noncardiac surgery: report of the American college of cardiology/American heart association task force on practice guidelines (committee on perioperative cardiovascular evaluation for noncardiac surgery). J Am Coll Cardiol. 1996;27:910–948.Google Scholar
  49. 49.
    Chipev CC, Simon M. Phenotypic differences between dermal fibroblasts from different body sites determine their responses to tension and TGFbeta1. BMC Dermatol. 2002;2:13.CrossRefPubMedGoogle Scholar
  50. 50.
    Smack DP, Harrington AC, Dunn C, et al. Infection and allergy incidence in ambulatory surgery patients using white petrolatum vs. bacitracin ointment: a randomized controlled trial. JAMA. 1996;276:972–977.CrossRefPubMedGoogle Scholar
  51. 51.
    Classen CD, Evans RS, Pestotnik SL, et al. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Eng J Med. 1992;326:281–286.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Thomas Stasko
    • 1
  • Amy Ross
    • 2
  1. 1.Department of DermatologyVanderbilt University Medical CenterNashvilleUSA
  2. 2.Palm Harbor Dermatology, Mohs Surgeon, Palm HarborMexicoUSA

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