Frontiers in surgery · 2026
Association between postoperative silver sulfadiazine dressings and surgical site infection after skin cancer excision: an observational cohort study with historical controls.
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De Angelis Barbara, Bottini Davide Johan, Di Segni Chiara, Secondi Lorenzo, Gerardi Marco, D'Autilio Margarida Fernandes Lopes Morais, Preite Nico, Pisapia Alfredo, Gentile Pietro, Crocoli Dario, Di Giovanni Daniele, Carestia Mariachiara, Palombi Leonardo, Orlandi Fabrizio, Cervelli Valerio
Аннотация
BACKGROUND: Surgical site infections (SSIs) remain a relevant postoperative complication in dermatologic surgery, negatively affecting wound healing, patient outcomes, and healthcare costs. Although the baseline infection risk after clean skin cancer surgery is relatively low, preventive strategies remain clinically important. Silver sulfadiazine (SSD) is a topical antimicrobial agent with broad-spectrum antibacterial activity; however, its preventive role in clean oncologic dermatologic surgery remains insufficiently investigated. This study evaluated the association between postoperative SSD-based dressings and SSI occurrence after skin cancer excision.
METHODS: A non-randomized observational cohort study with a non-concurrent historical control group was conducted including 800 patients undergoing excision of basal cell carcinoma or squamous cell carcinoma. The intervention group (n = 400) prospectively received postoperative SSD-based dressings, whereas the control group (n = 400) consisted of historical controls treated with paraffin gauze alone before implementation of the SSD protocol. The primary endpoint was SSI occurrence at postoperative day 3 (T1), defined as Southampton Wound Assessment Scale (SWAS) grade ≥ II. Relative risk (RR) and 95% confidence intervals (CIs) were calculated.
RESULTS: At T1, SSIs occurred in 36/400 patients (9.0%) in the SSD group compared with 72/400 patients (18.0%) in the control group (RR = 0.50; 95% CI: 0.34-0.73; p < 0.001). No additional infections were observed during subsequent follow-up evaluations (T2-T4). Recorded baseline demographic and clinical characteristics were broadly comparable between groups.
CONCLUSION: Postoperative SSD-based dressings were associated with a lower incidence of early SSI after skin cancer excision. Because of the non-randomized design and the use of non-concurrent historical controls, the observed reduction should be interpreted as an association rather than proof of causality. Further prospective randomized studies are warranted.
METHODS: A non-randomized observational cohort study with a non-concurrent historical control group was conducted including 800 patients undergoing excision of basal cell carcinoma or squamous cell carcinoma. The intervention group (n = 400) prospectively received postoperative SSD-based dressings, whereas the control group (n = 400) consisted of historical controls treated with paraffin gauze alone before implementation of the SSD protocol. The primary endpoint was SSI occurrence at postoperative day 3 (T1), defined as Southampton Wound Assessment Scale (SWAS) grade ≥ II. Relative risk (RR) and 95% confidence intervals (CIs) were calculated.
RESULTS: At T1, SSIs occurred in 36/400 patients (9.0%) in the SSD group compared with 72/400 patients (18.0%) in the control group (RR = 0.50; 95% CI: 0.34-0.73; p < 0.001). No additional infections were observed during subsequent follow-up evaluations (T2-T4). Recorded baseline demographic and clinical characteristics were broadly comparable between groups.
CONCLUSION: Postoperative SSD-based dressings were associated with a lower incidence of early SSI after skin cancer excision. Because of the non-randomized design and the use of non-concurrent historical controls, the observed reduction should be interpreted as an association rather than proof of causality. Further prospective randomized studies are warranted.