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    Standard practices for cutaneous surgery

    Anticoagulant medication should be continued during cutaneous surgery, if considered medically necessary, according to an effort to close practice gaps in cutaneous surgery.

    In a recent article in JAMA Facial Plastic Surgery, researchers identified 73 peer-reviewed publications about cutaneous surgery, Mohs micrographic surgery and plastic surgery, from 2000 to 2016, by searching PubMed/MEDLINE. Bibliographies from these references, plus meta-analyses, were also taken into account.

    “We hope this article, which summarizes the newest literature in cutaneous surgery, will help guide cutaneous surgeons in their practices and increase patient safety, outcomes and satisfaction,” says co-author Kathryn Kreicher, who in May is graduating from Case Western Reserve University School of Medicine in Cleveland, OH, and will be a resident in otolaryngology-head and neck surgery at the University of Connecticut beginning July 2017.

    According to Dr. Kreicher, principal author Jeremy Bordeaux, M.D., director of Mohs Micrographic and Dermatologic Surgery at University Hospitals Cleveland Medical Center found through discussions with colleagues “that dermatologists and other surgeons who perform cutaneous surgery have different standard practices for their patients preoperatively, intraoperatively and postoperatively. For example, surgeons differ on whether to continue anticoagulation, what type of anxiolysis to use and whether to prescribe opioids for postsurgical pain.”

    Besides the review pointing out that anticoagulant and antiplatelet medication should be continued during surgery, “Anxiety is best addressed with music or anxiolytic drugs, and postoperative pain can generally be managed without opioid medications,” Dr. Kreicher says.    

    Unexpectedly, authors also found in their review that topical antibiotics do not reduce postoperative wound infections. “In fact, these ointments are more costly and are more likely to cause allergic contact dermatitis, and thus we recommend using an alternative such as white petrolatum for wound care,” Dr. Kreicher says.

    NEXT: The ‘Standard Practice’ Checklist

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