Surgical Complications at a Glance
- Complications in dermatologic surgery are relatively uncommon.
- Complications are best avoided by
- Obtaining patient history of medications, prior bleeding episodes, allergies, and prior surgeries.
- Observing asepsis during procedure.
- Gentle handling of tissue.
- Complete cessation of bleeding at time of surgery.
- Good wound care by patient after surgery.
Surgical complications are unexpected problems that arise in association with an operation. Although the surgeon is always vigilant to minimize complications, adverse outcomes will inevitably occur. This chapter focuses on preventing, identifying, and treating common complications seen with skin surgery. One recently discussed method to minimize complications is the use of a surgical checklist similar to one used by airplane pilots.1
Most complications that occur on the day of surgery involve the patient's underlying medical problems, reactions to administered anesthetics, and bleeding. Allergy, hypersensitivity, or toxic reactions to local anesthetics and fainting with or without seizure can also occur.
Patient's Medical Problems
Before surgery, it is important to obtain a medical history and perform a physical examination. The level of physical examination is commensurate with the extensiveness of the surgery that is planned. For example, a small cyst excision would only require a cursory physical exam (i.e., general appearance) and vital signs, whereas an extensive liposuction procedure using a large volume of tumescent anesthesia would require a full physical examination and diagnostic testing, if indicated.
The patient's medical history, including allergies, medications, and past surgeries, is important to obtain. Medications such as anticoagulants, pain medications, and certain herbs can affect bleeding at the time of surgery (Table 247-1).2,3 Excessive bleeding with prior surgeries, especially if requiring transfusions, can be associated with a prolonged bleeding time. It is important to determine if the patient has a cardiac pacemaker, defibrillator, or any other implantable medical devices. Also, if the patient has an artificial heart valve or a rheumatic heart valve, preoperative antibiotics will be required.
Table 247-1 Medications that Inhibit Platelet Function |Favorite Table|Download (.pdf)
Table 247-1 Medications that Inhibit Platelet Function
- Vitamin E
- Ginkgo biloba
- Asian ginseng
- Nonsteroidal anti-inflammatory drugs
Some of the common problems associated with skin surgery include fainting, seizures, and diaphoresis. Fainting is almost always a vasovagal reaction, and the best treatment is to position the patient in the Trendelenburg position. Seizures sometimes occur with the vasovagal reaction and are short lived. Usually, when patients faint, there is a history of fainting episodes, pointing out the importance of inquiring about this in the medical history. Diaphoresis may occur associated with a vasovagal reaction, angina, or hypoglycemia.
Certain equipment is necessary to address emergencies. A “crash cart” includes ...