Prevention and Treatment of Bleeding Complications in Dermatologic Surgery

In general, the rate of complications in dermatologic surgery is extremely low. A single-center prospective analysis of 1,343 cases of Mohs micrographic surgery reported an overall complication rate of 1.6% (22/1,343), including wound infection, postoperative hemorrhage, hematoma, wound dehiscence, and flap or graft necrosis [1] (IV/B). This chapter reviews the available evidence regarding the prevention and management of bleeding complications of cutaneous surgery. Although much of the data will be generated from the collective dermatologic experience with Mohs micrographic surgery, the conclusions drawn will be applicable to standard excisional surgery, as well other common procedures of the dermatologist and dermatologic surgeon. Not only is peri-operative bleeding the most common complication associated with cutaneous surgery, but it is also the subject for which the most robust evidence exists. It is additionally important to note that complications involving dehiscence, necrosis, poor wound healing, and infection often occur after difficulties with hemostasis.