title: Prospective evaluation of dermatologic surgery complications including patients on multiple antiplatelet and anticoagulant medications.
abstract: BACKGROUND
  Few prospective studies have evaluated the safety of dermatologic surgery.
  
  
  OBJECTIVE
  We sought to determine rates of bleeding, infection, flap and graft necrosis, and dehiscence in outpatient dermatologic surgery, and to examine their relationship to type of repair, anatomic location of repair, antibiotic use, antiplatelet use, or anticoagulant use.
  
  
  METHODS
  Patients presenting to University of Massachusetts Medical School Dermatology Clinic for surgery during a 15-month period were prospectively entered. Medications, procedures, and complications were recorded.
  
  
  RESULTS
  Of the 1911 patients, 38% were on one anticoagulant or antiplatelet medication, and 8.0% were on two or more. Risk of hemorrhage was 0.89%. Complex repair (odds ratio [OR] = 5.80), graft repair (OR = 7.58), flap repair (OR = 11.93), and partial repair (OR = 43.13) were more likely to result in bleeding than intermediate repair. Patients on both clopidogrel and warfarin were 40 times more likely to have bleeding complications than all others (P = .03). Risk of infection was 1.3%, but was greater than 3% on the genitalia, scalp, back, and leg. Partial flap necrosis occurred in 1.7% of flaps, and partial graft necrosis occurred in 8.6% of grafts. Partial graft necrosis occurred in 20% of grafts on the scalp and 10% of grafts on the nose. All complications resolved without sequelae.
  
  
  CONCLUSIONS
  The study was limited to one academic dermatology practice.
  
  
  CONCLUSIONS
  The rate of complications in dermatologic surgery is low, even when multiple oral anticoagulant and antiplatelet medications are continued, and prophylactic antibiotics are not used. Closure type and use of warfarin or clopidogrel increase bleeding risk. However, these medications should be continued to avoid adverse thrombotic events.
authors.affiliation: Department of Dermatology, University Hospitals Case Medical Center, Cleveland, Ohio; Case Western Reserve University School of Medicine, Cleveland, Ohio. Electronic address: Jeremy.Bordeaux@UHhospitals.org.
authors.forename: Jeremy S
authors.initials: JS
authors.lastname: Bordeaux
authors.affiliation: Case Western Reserve University School of Medicine, Cleveland, Ohio.
authors.forename: Kathryn J
authors.initials: KJ
authors.lastname: Martires
authors.affiliation: Division of Dermatology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Dori
authors.initials: D
authors.lastname: Goldberg
authors.affiliation: Dermatology Associates of Wisconsin, Manitowoc, Wisconsin.
authors.forename: Sean F
authors.initials: SF
authors.lastname: Pattee
authors.affiliation: Case Western Reserve University School of Medicine, Cleveland, Ohio.
authors.forename: Pingfu
authors.initials: P
authors.lastname: Fu
authors.affiliation: Division of Dermatology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Maloney
mesh_terms: D000368:Aged; D000556:Ambulatory Surgical Procedures; D019072:Antibiotic Prophylaxis; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D000077144:Clopidogrel; D062109:Dermatologic Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D015580:Mohs Surgery; D009336:Necrosis; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000139:chemically induced*; D019106:Postoperative Hemorrhage / Q000139:chemically induced*; D013524:Surgical Flaps / Q000473:pathology; D013530:Surgical Wound Infection / Q000517:prevention & control; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D000077144:Clopidogrel; D013988:Ticlopidine