Intra-incisional prophylactic antibiotics for dermatologic surgery.

OBJECTIVE

To determine the efficacy of intra-incisional antibiotics in decreasing the risk of wound infections in cutaneous surgery.

DESIGN

Prospective, blinded, randomized, placebo-controlled trial conducted during an 8-month period.

SETTING

A private practice Mohs micrographic surgery referral center.

PATIENTS: Seven hundred ninety consecutive patients referred for Mohs surgery or other dermatologic surgery were randomized to receive anesthesia either with study compound or placebo. The 2 groups were equivalent with respect to age and sex distribution and the lesions treated were similar in character. No patients were withdrawn for adverse effects.

INTERVENTIONS: Patients received local anesthesia before surgery with either buffered lidocaine hydrochloride or a solution consisting of nafcillin sodium in buffered lidocaine.

MAIN OUTCOME MEASURES: All surgical wounds were evaluated in a blinded fashion at the time of suture removal (5-7 days) and scored according to a standardized assessment chart based on erythema, edema, and the presence of purulent discharge.

RESULTS

Seven hundred ninety consecutive patients with 908 surgical wounds were enrolled in this study. A total of 12 wound infections were recorded. Eleven (2.5%) of these occurred in the control group, while only 1 (0.2%) occurred in the nafcillin group. This difference was highly significant (P = .003). Observers were blinded to patient groupings particularly for surgical wound scoring.

CONCLUSIONS

This study offers strong supporting data for the use of a single intra-incisional dose of an antibiotic administered immediately before dermatologic surgery. The use of nafcillin and buffered lidocaine solution is inexpensive, safe, convenient, and effective.