Uso de antibióticos en cirugía dermatológica: revisión / Use of antibiotics in dermatologic surgery: review

El uso de antibióticos tópicos y orales debe asumirse con cautela. Los antibióticos orales deben ser prescritos considerando herida de alto riesgo, y paciente de alto riesgo. Las heridas de alto riesgo son las que se realizan en sitios infectados, alteraciones músculoesqueléticas, y mucosa oral. Los pacientes de alto riesgo incluyen los susceptibles a desarrollar endocarditis bacteriana, y los que han recibido recambio protésico de algún tipo, bajo procedimientos dermatológicos de alto riesgo. Ciertas áreas del cuerpo ­no obstante- como la rodilla, axila e ingle, y cirugías reconstructivas como resecciones en labios y nariz, están asociadas a una mayor tasa de infección, y podrían requerir antibióticos profilácticos. Existen amplias controversias en el uso de antibióticos, como su asociación a enfermedades respiratorias en uso a largo plazo, o mayor probabilidad de reacciones alérgicas. Quizá la onicocriptosis es la más controversial de las indicaciones antibióticas, en donde varios estudios se pronuncian a favor y en contra

Topical and oral antibiotics should be used with caution. Antibiotics must be indicated in high risk wounds, and high risk patients. High ­ risk wounds include involvement of oral mucosa and surgery performed on clinically infected skin, or musculoskeletal tissue. High ­ risk patients include those susceptible to develop bacterial endocarditis, and those who have received any prosthetic joint, undergoing high ­ risk dermatologic procedures. Nevertheless, some sites of the body, such as knee, armpit and groin, and reconstructive surgery as skin flaps in nose and lips, are associated with a high infection rate, and would need antibiotic prophylaxis. There are a lot of controversies with the use of antibiotics, because they can produce upper respiratory tract infections in the long ­ term use, or high risk of allergy. Perhaps, onychocryptosis is the most controversial matter, with several researchs pro and against the use of antibiotics

Ingrown toenails.

Onychocryptosis or ingrown toenail is a very common pathology of the toenail unit, chiefly affecting adolescents and young adults. The ingrown toenail is responsible for disabling complaints like pain and difficulty in walking. It is associated with significant morbidity, hampering the quality of life as it interferes with sporting activities, school, or work. It principally occurs in the hallux. It is ascribed to poor trimming of the nails in combination with local pressure due to ill-fitting footwear, hyperhidrosis, poor foot hygiene and nail abnormalities. Pain, swelling and discharge are the main clinical features. Four stages of the condition have been described. Diagnosis is usually evident, but it should be differentiated from subungual exostosis and tumors of the nail bed. The current standard of care focuses on conservative treatment like the gutter splint technique in the initial stages, and in cases that are resistant to medical management or recurrent, surgical correction is the treatment of choice. There are various surgical techniques that are described in literature. Although there is no ideal technique, lateral nail plate avulsion with lateral matricectomy by phenol is commonly used and reported to be more effective in reducing recurrences. The aim of this review article is to focus on this common pathology of the nail, the various techniques employed in management and aid in the selection of treatment according to the stage and severity of the disease.