Dermatology inpatients susceptible to wound complications following diagnostic skin biopsies

Key Points

Newcastle upon Tyne, England - Inpatient diagnostic skin biopsies can be susceptible to wound complications. According to the results of a recent study, host factors as well as procedural factors play intricate roles in increasing the risk of wound complications following biopsy.

"We had noticed, generally, that post-biopsy wound infections were more common in dermatology inpatients than outpatients. This prompted us to undertake a study to identify the risk factors for wound complications following diagnostic biopsies in dermatology inpatients.

"Identifying and understanding the variables could help us ultimately decrease wound complications," says Shyamal Wahie, M.B., M.R.C.P., department of dermatology, Royal Victoria Infirmary.

In these 27 biopsies where clinical infection was evident, positive bacterial isolates were found in 24 (Staphylococcus aureus, streptococcus and methicillin-resistant Staphylococcus aureus was isolated in 15, four and five of the biopsies, respectively).

"We found two significant host risk factors and two significant procedural risk factors that played a role in wound complications, namely smoking and oral corticosteroid use, as well as anatomical location of biopsy and the operating room setting," Dr. Wahie tells Dermatology Times.

Results showed that wound complications were seen in 64 percent of smokers and only 12 percent of non-smokers, and 63 percent of patients taking oral corticosteroids and only 21 percent who did not. Wound complications were seen in 48 percent biopsies taken below the waist, as opposed to only 23 percent taken above the waist.

Also, biopsies conducted in an outpatient operating theater rather than on a ward were less likely to result in wound infection.

According to Dr. Wahie, this setting discrepancy may be explained by differences in the facilities and staff available, but may also be because very ill patients could not be moved easily to an out-patient operating theatre.

"What we have changed in our department as a result of this study is to recommend that all biopsies, whenever possible, should be done in the outpatient-dedicated operating theatre room, rather than on the ward.

"Secondly, we try to biopsy above the waist when possible, and warn patients who are smokers or are taking oral steroids that there might be a higher risk of wound complication/infection," Dr. Wahie says.

"We were expecting a higher risk of wound complications in inpatients compared to outpatients following skin surgery, because dermatology inpatients differ from outpatients in the sense that they are likely to be more unwell and have widespread skin disease colonized with Staphylococcus aureus," Dr. Wahie says.

He says that in his study, 50 percent of the biopsies performed under antibiotic cover still developed wound infections postoperatively.

According to Dr. Wahie, the patients who developed the wound infections may have developed these complications because they had widespread skin disease and were not well. Clearly, in this group, perioperatively administered antibiotics were not fully effective in wound infection prevention.

The study also demonstrated that wound infection was less likely to occur if subcutaneous sutures were used in elliptical biopsies compared with when they were not used.

"In conclusion, in this study we have demonstrated that inpatients in dermatology wards are at risk of wound complication after diagnostic surgery. We have identified significant host and procedural risk factors and these findings may be valid for other regional centers with inpatient units in which diagnostic biopsies are frequently performed by a physician," he says.