Complications of tissue ischemia in dermatologic surgery.

Ischemic complications in cutaneous surgery can be devastating. Tissue ischemia can result from improper technique or closure design (i.e., increased tension), inadequate hemostasis, or infection, all of which result in decreased blood supply to the surgical site. Knowledge of patient characteristics that affect blood supply to the surgical site, including comorbid conditions, medications and behaviors (i.e., tobacco and alcohol use), is essential. Also, a thorough understanding of cutaneous anatomy, principles of surgical design, coupled with meticulous technique will minimize the likelihood of ischemic complications. Prompt recognition of hematoma, infection and impending ischemia/necrosis, and proper treatment of such complications, can minimize poor outcomes.