The Patient

Patient factors are very important in deciding the nature of surgery you will perform or whether to refer the case. Unrealistic patient expectations or unreasonable concerns about scarring are red flags for referral. Patients who are diabetic, on blood thinners or who readily get skin infections from surgery require pre planning with withdrawal of blood thinners if feasible, prophylactic antibiotics and or post op bed rest particularly for diabetics with leg swelling and impaired peripheral circulation.Look at the videos below on these issues.

Preoperative assessment of the patient is important. You need to know the patient's medical history, especially drugs that might interfere with clotting or the normal healing process. You need to know how they heal. Do they suffer from hypertrophic or keloid scarring? Some people unfortunately develop hypertrophic scars and others develop true keloids. There are certain areas of the body where the risk of developing keloids is increased such as the anterior chest, the shoulder, over the breast area in females and sometimes on the upper back. It is also a problem if you are trying to do surgery across joints. Are they bleeders despite not being on blood thinning drugs? (Check clotting times if not sure!) Do they regularly get wound infections after skin surgery? (Check for MRSA carriage and cover with an oral anti staph antibiotic.) Listen to this exhaustive lecture from MD LIVE on the preoperative patient assessment. It covers the topics mentioned above and then some!