Lower extremities have highest surgical site infection rates with Mohs surgery

Lower extremities have the highest rates of surgical site infections following Mohs micrographic surgery (MMS), according to a research letter published online June 24 in the Journal of the American Academy of Dermatology.

Ailynna Chen, M.D., M.P.H., from the University of Iowa Carver College of Medicine in Iowa City, and colleagues conducted a systematic review to provide a quantitative estimate of SSI rates across different MMS closure techniques with stratification by body site.

Based on 27 included reports, the researchers identified 2,252 flap/graft closures; 3,818 primary closures; and 1,434 secondary intention healing cases. The researchers observed a significant difference between body sites, with lower extremities having the highest SSI rates across all closure types.

For head and neck, the pooled SSI rates were 0.01 for flap/graft closures, <0.01 for primary closure, and <0.01 for secondary intention healing; for lower extremity SSI, the corresponding rates were 0.11, 0.05, and 0.04. Except for one study with high risk of bias, studies had low-to-moderate risk of bias.

"While previous studies suggest that heightened sterility practices (i.e., sterile gloves, single-use instruments, antibiotic prophylaxis) are generally unnecessary for MMS, closure type, body site, and other patient characteristics should also be considered," the authors write.

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