Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]
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Although the risk of postoperative infection and bacteremia from dermatologic procedures remains low, many dermatologic surgeons continue to prescribe antibiotics, pre- and postoperatively. This practice can lead to unwanted morbidity and mortality and significantly increases associated healthcare costs and, even more ominously, increases bacterial resistance in the community. ⋯ We focused on the most common bacterial pathogens related to surgical sites and effective antibiotics for each. In doing so, we seek to limit the unwarranted use of antibiotics in dermatologic surgery.
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Comparative Study Clinical Trial
Prospective comparison between buffered 1% lidocaine-epinephrine and skin cooling in reducing the pain of local anesthetic infiltration.
Pain associated with the infiltration of local anesthesia is attributed to the acidity of the solution. Buffering with sodium bicarbonate has been used widely to reduce this affect. Growing evidence supports skin cooling (cryoanalgesia) as a measure to reduce infiltration pain. ⋯ There is no significant difference between buffered anesthetic solution (buffering) and skin cooling in reducing the pain of infiltration of 1% lidocaine - epinephrine.
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Randomized Controlled Trial Comparative Study
Multimodal quantitative analysis of early pulsed-dye laser treatment of scars at a pediatric burn hospital.
The pulsed-dye laser (PDL) is a potential adjunctive therapy for treatment of hyperemic and hypertrophic scars. ⋯ PDL treatment in combination with CT appears to reduce scar hyperemia and height and normalize the biomechanical properties of burn-related scars.
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Approximately one in four patients undergoing dermatologic surgery takes an antithrombotic medication. When approaching the management of antithrombotic agents, procedural dermatologists must balance surgical outcomes, bleeding risks, and cardiovascular protection. Continuing antithrombotics during surgery increases the risk hemorrhage, but discontinuation of these agents may increase the risk of thrombotic events. Despite increasing evidence for continuation of antithrombotics during dermatologic surgery, few official guidelines exist, and clinicians have been slow to integrate new evidence into clinical practice. A study in 2007 reported that more than 40% of dermatologic surgeons sometimes discontinue warfarin for surgery. ⋯ Although there are concerns regarding bleeding, there are no reports of life-threatening hemorrhage from continued antithrombotic therapy in dermatologic surgery. Furthermore, potentially fatal cardiovascular events after cessation of medically indicated antithrombotic medications are increasingly recognized, leading to the growing acceptance that the risk of stopping most antithrombotics may outweigh the risks of bleeding incurred by continuing antithrombotic therapy.