๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
Intraincisional antibiotics
Intraincisional antibiotics
Local injection of antibiotic formulations in the perioperative period has been investigated for dermatologic surgery. While local injection of aminoglycosides may be helpful to reduce the infection risk on open fractures,57 one challenge in dermatologic surgery remains the vanishingly low baseline rate of SSI, making any effect challenging
to detect in a clinical trial setting.
One study demonstrated a statistically significant benefit to local intraincisional clindamycin injection for Mohs micrographic surgery cases.58 This work was follow-up to an earlier report on the use of intraincisional nafcillin.59 The solution for intraincisional clindamycin use was prepared by adding 0.15 mL of clindamycin (150 mg/mL) to a 50-cc bottle containing lidocaine (1%) with epinephrine (1:100,000) buffered with sodium bicarbonate (5 mL of an 8.4% solution). The authors noted that the solution retained its bactericidal properties for at least 1 month after preparation; given the low cost of clindamycin, it has been advocated as a reasonable approach in select patients and wounds. While this approach is not used broadly for all surgical cases, it may be a useful adjunct for wounds or patients at elevated risk of developing SSI.
CONCLUSIONS
Antibiotic use is a critical part of dermatologic surgery, though appropriate antibiotic use remains a significant challenge facing surgeons and patients. Given the low baseline SSI risk for most dermatologic surgery procedures, antibioticsโwhether oral, topical, or intraincisionalโare not routinely prescribed. For higher-risk surgical sites or patients with significant risk factors, however, antibiotics may play an important role in decreasing an elevated infection risk. In cases of active infection, antibiotic use, ideally guided by culture and sensitivity results, is warranted. All true abscesses, while rare, require drainage in addition to antibiotic treatment.