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Skin Surgery in Patients with Diabetes
In patients undergoing skin surgery, diabetes was associated with increased risk for wound infections.
Patients with diabetes are thought to have increased risk for surgical complications, but little information is available about the specific problems encountered by these patients in skin surgery. In this prospective, observational study from Australia, 4197 patients underwent a total of 7224 skin-lesion excisions by one surgeon over a 5-year period. Researchers compared the rate of complications in patients with and without diabetes. Of the patients, 4.7% reported a history of diabetes. The multivariate analysis controlled for age, sex, smoking, antithrombic medication, lesion site, and type of closure.
Postoperative wound infections developed in 4.2% of patients with diabetes versus 2.0% of nondiabetic patients. After multivariate statistical analysis, those with diabetes had a 66% higher risk for infection. Other complications — including bleeding, dehiscence, edge necrosis, contact dermatitis, wound depression or elevation, hypertrophic scar or keloid, pain, hypergranulation, granuloma formation, and deep scar — occurred at similar rates in both patient groups, with an overall rate of 1.8% in each group. Leg wounds in all patients were almost 4 times more likely to become infected than were wounds located elsewhere, and patients with flap or graft repair were 3.5 times more likely to develop wound infections.
Comment: Diabetes, leg wounds, and more complicated repairs, such as flaps and grafts, were associated with increased risk for infection. This study did not show other problems of healing that are often ascribed to diabetes. It may be prudent to consider patients with diabetes, like those with leg and ear lesions, as candidates for prophylactic antibiotics before skin surgery.
Published in Journal Watch Dermatology August 14, 2009
Citation(s):
Dixon AJ et al. Prospective study of skin surgery in patients with and without known diabetes. Dermatol Surg 2009 Jul; 35:1035.
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