No infection increase seen after dermatologic surgery with early water exposure

Key takeaways:

• Needing to keep surgical wounds dry for 24 to 72 hours postoperatively interferes with hygiene and daily life.
• Surgical wounds that were wet early did not have higher infection or scarring rates.

Dermatologic surgery wounds that were exposed to water in the hours following surgery did not experience an increase in infection, hematoma or bruising, according to a study.

“As the incidence of nonmelanoma skin cancer increases, more effort has been directed toward establishing evidence-based changes in patient care,” Christen Samaan, MD, of Penn State Hershey Medical Center, and colleagues wrote. “Multiple studies investigating wound management have shown that the speed and quality of healing are most drastically affected by dehydration of exposed tissue, status of the blood supply to the area and sepsis of the wound.”

With this, patients are most often told to keep their post-operative bandages dry for 24 to 72 hours, with some physicians suggesting up to a week of dryness. However, these directives often interfere with daily activity, bathing and exercise.

This investigator-blinded, randomized, controlled trial aimed to determine if being exposed to water in the first 6 hours after surgery would influence infections.

The study included 437 patients undergoing standard excisional surgery or Mohs micrographic surgery for benign and malignant lesions who were randomly assigned to the intervention cohort (n = 218), removing wound dressings after 6 hours and wetting the wound for at least 10 minutes, or the standard cohort (n = 219), keeping dressings dry and intact for 48 hours.

On subsequent days, all patients were told to wash their wounds with soap and water and reapply clean dressings and white petrolatum.

The standard treatment cohort had a post-infection rate of 1.4%, whereas those in the early intervention cohort had a rate of 1.8%. Seven (3.2%) patients in the standard cohort and six (2.8%) in the intervention cohort met clinical criteria and were started on antibiotics; however, two in the standard cohort and one in the intervention cohort had negative cultures and antibiotics were stopped.

The differences in infections were not statistically significant between the two groups.

A hematoma developed in six patients in each group, for a total of 12 (2.9%).

Scar quality was assessed at 6 months using the Patient and Observer Scar Assessment Scale, with a mean patient score of 15.7 and 13.7 and mean observe score of 15.8 and 18.6 in the standard and intervention cohorts, respectively. Neither differences were not considered significant.

“Early water exposure in the immediate post-operative period does not lead to increased risk of infection, hematoma or bruising and does not compromise scar cosmesis,” the authors wrote. “We hope that these findings will allow us to develop evidence-based guidelines to better advise patients and allow them to continue routing personal hygiene practices in the immediate post-operative period.”