INTRODUCTION
Dermatologic surgery, including Mohs micrographic surgery (MMS) and wide local excision (WLE), is associated with low rates of intraoperative and postoperative adverse effects. Futoryan and Grande found a combined infection rate of 2.3% when analyzing over 1,000 cases of both MMS and cutaneous excisions in 1995.1 A 2013 multicenter, prospective cohort study evaluating over 20,000 MMS procedures reported an adverse event incidence rate of 0.72%, with surgical site infections (SSI) being the most common adverse event reported.2There is an increased risk of SSI following dermatologic surgery on the lower extremities; an analysis of over 5,000 dermatologic surgery cases found a below the knee infection rate of 6.9%.3 Because of the increased SSI rate in the lower extremities, dermatologic surgeons routinely recommended the use of prophylactic antibiotics in patients undergoing dermatologic surgery below the knee.3 An advisory statement in 2008 reinforced this notion, urging surgeons to adopt prophylactic cephalexin.4 A 2012 review of antibiotic prophylaxis in dermatologic surgery echoed this appeal for prophylactic cephalexin in below the knee procedures.5To our knowledge, there are no studies investigating whether prophylaxis with doxycycline is superior to prophylaxis with cephalexin in the prevention of SSI on the lower extremities following dermatologic surgery. The choice of which prophylactic antibiotic to use, if any, is still largely left to the surgeon and is often determined on a case by case basis.5-7The objective of this study was to identify the clinical characteristics associated with SSI following dermatologic surgery below the knee. The type of procedure was examined to gauge if MMS or WLE were associated with differing infection rates. Additionally, the type of suturing method used was reviewed given the theoretic potential that running suture techniques may decrease perfusion to the skin. It is the surgeon’s choice which cutaneous suturing method to use, and the considerations include: tension, anatomical location, need for eversion and/or hemostasis, cosmesis, and time required to suture. Other clinical characteristics included patient comorbidities, as higher infection rates have previously been found in diabetic patients, immunosuppressed patients, smokers, and patients on anticoagulant medications.8-10
METHODS
This study was approved by the Institutional Review Board of the University of California, San Diego (UCSD). Using the Epic electronic medical record system, the authors reviewed the
