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PREOPERATIVE CONSIDERATIONS
PREOPERATIVE CONSIDERATIONS
The preoperative risk for surgical complications is a function of patient factors, including medical comorbidities, medications, and behaviors, and the procedure being performed. The degree of preoperative assessment should be dictated in part by the extent of the procedure. Dermatologic procedures such as cryotherapy and shave biopsies are low risk, while flaps, grafts, MMS, and large excisions are considered higher risk. Patient risk factors may impact the surgeonโs choice of surgical modality or the type of surgical reconstruction performed. Prior to the procedure, the patient should be counseled in detail on the expected postoperative course, including activity limitations, wound care, pain control, and medication management.
A thorough preoperative evaluation includes a medical history and physical examination. Diabetes, hypertension, liver failure, renal failure, immunosuppression, inherited bleeding disorders, inflammatory skin conditions, and prior radiation therapy are examples of conditions that can complicate dermatologic surgery.6 A thorough list of medications and supplements should be collected; many medications may impact intraoperative and postoperative bleeding. The surgeon should also assess and quantify the patientโs smoking and alcohol consumption. Alcohol use and smoking may increase the risk of complications, and even minor decreases in consumption can improve postoperative results.6 Identifying patients with implantable electrical cardiac devices or other implantable electric devices can guide the safe use of electrosurgery.7 Allergies, particularly medication reactions and prior reactions to latex or other medical materials, should be obtained. Vital signs may be obtained on the day of surgery as part of the physical examination. While there is a range of blood pressures within which dermatologic surgeons comfortably operate, one comprehensive review suggests that for patients with a systolic pressure โค180 mmHg and diastolic pressure โค100 mmHg and no other medical contraindications, cutaneous surgery may proceed.8 Higher blood pressures often warrant surgical deferment. Many surgeons rely on patientreported history to ascertain whether a history of uncontrolled hypertension exists. Surgery should be avoided on areas of active infection or inflammation.