Antibiotic prophylaxis in cutaneous surgery

Background: Postoperative wound infections, endocarditis, and late contamination of prosthetic implants arc potential complications of cutaneous surgery. Objective: To review current American Heart Association guidelines and their application to cutaneous surgery, and to determine how practicing physicians approach this problem. Method. Surveys were sent to dermatologists to determine what kind of preoperative screening was being done and how antibiotics were being used. Results: The most common indications for prophylaxis were manipulation of infected tissue in patients undergoing any procedure, and any procedure in a patient with a prosthetic heart valve. Some respondents used antibiotic prophylaxis for all procedures, while others never used antibiotics in any surgical procedure. Cephalosporins and erythromycin were the most commonly used antibiotics and they were usually given orally, one dose before and one dose after surgery. Conclusion: Scientific literature supports the use of antibiotic prophylaxis for endocarditis in two situations: 1) surgical procedures on infected tissue in patients with a high risk cardiac lesion; and 2) any surgical procedure in a patient with a prosthetic heart valve. Our survey suggests that the majority of dermatologists obtain pertinent medical history and use appropriate antibiotic prophylaxis in these two situations. But the survey also suggests that antibiotic prophylaxis is used in a variety of situations where indications for use are not as clear, and sometimes prophylaxis is not used when it should be.