Flaps or grafts for closure of lower extremity larger wound sizes are associated with an increased risk of surgical site infection in lower extremity MMS cases, according to a recent study published in Dermatologic Surgery.
A surgical site infection is an infection that occurs after surgery in the part of the body where the surgery took place. Surgical site infections can sometimes be superficial infections involving the skin only. Other surgical site infections are more serious and can involve tissues under the skin, organs, or implanted material. Surgical site infection (SSI) is the most common complication for Mohs micrographic surgery (MMS). It is a surgical procedure used to treat skin cancer. Individual layers of cancer tissue are removed and examined under a microscope one at a time until all cancer tissue has been removed. Also called Mohs surgery. Lower extremity surgical sites are at an increased risk for developing SSI.
This study aimed to evaluate lower extremity SSI rates post-MMS based on closure type and antibiotic usage. A retrospective review was performed of all lower extremity MMS cases from 2011 to 2016 at Vanderbilt University Medical Center. Patient history, surgical details, and follow-up appointments were reviewed.
The Results of the study are as follows:
Six hundred twenty MMS lower extremity surgeries were eligible. The review identified an overall lower extremity SSI rate of 7.4%. Infection rates were significantly increased in wounds closed by flaps/grafts (p < .001). Although wound size and preoperative antibiotic prophylaxis were initially associated with increased infection rate (p = .03, p = .015), the associations were fully attenuated when adjusting for closure type.
Thus, the researchers concluded that more complicated repair techniques (flap/graft) for larger wound sizes contribute to increased SSI risk among lower extremity MMS cases. Providers can use this information to guide antibiotic prophylaxis.
Reference:
Characteristics of Lower Extremity Infection Rates Following Mohs Micrographic Surgery by Niklinska, Eva et al. published in the Dermatologic Surgery.
https://journals.lww.com/dermatologicsurgery/fulltext/2021/12000/characteristics_of_lower_extremity_infection_rates.3.aspx