NEW YORKThe severity of postsurgical complications can be mitigated by knowing the warning signs and best management techniques, Dr. James M. Spencer said at a meeting on medical and surgical dermatology sponsored by Mount Sinai School of Medicine.
Some bruising, for example, is very common after dermatologic surgery. If it's performed in the periocular region, patients can expect to have a black eye. "This can obviously be very alarming to patients, but generally reassurance is all that's necessary," said Dr. Spencer of the department of dermatology at Mount Sinai in New York.
In the case of minor bleeding, advise patients to try direct pressure for 1015 minutes and apply ice. If the bleeding can't be controlled easily from home, the patient will have to come back in. He advised using lidocaine alone when numbing the wound area because epinephrine causes vasoconstriction and will make it hard to recognize bleeding problems.
A hematoma puts pressure on the wound and is an excellent growth medium for bacteria. Initially, the clot will be gelatinous and generally can be easily evacuated through a small opening, but once it organizes, it will be difficult to remove. Wait 710 days for the clot to liquify and reabsorb, Dr. Spencer said.
Like a hematoma, a seroma puts pressure on the wound. This generally can be evacuated with an 18-gauge needle, he said.
A wound infection usually manifests 34 days after surgery and the classic signs include pain, redness, and swelling. Although gram-positive infection is most likely in dermatology, there are certain areas of the body where other infections also are likely. Pseudomonas should be considered on the ear and gram-negative infections in the groin and lower leg, Dr. Spencer said.
Contact dermatitis can mimic infection, though if the area is red and itchy, that's a clue that it could be contact dermatitis. Patients may have an allergic reaction to either the topical antibiotic or to the glue of the bandage. Remove the offending agent and put the patient on a short course of topical steroids, he said.
When there is dehiscence, there are two choiceseither resuture or allow the wound to heal by second intention. "Second intention, I think, is underutilized. You can get terrific results," he said. If the wound is resutured, wash it, but don't debride the wound edges excessively.
One of the worst postsurgical complications is necrosis. If the flap or graft is blue, then blood is going in but is not getting back out. In that case, try nitroglycerin cream to increase venous return. However, if the flap or graft becomes black, adherent, and crusted, that is necrosis. The physician should do nothing and wait for it to slough on its own. Since it's not apparent how deep the necrosis goes, there could be a viable dermis underneath it. Debriding it just creates a large open wound, Dr. Spencer said.