Practical Dermatology
Acute Skin Lesions After Surgical Procedures: A Clinical Approach
Lesiones cutáneas agudas tras intervenciones quirúrgicas. Aproximación clínica
L. Borrego
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Servicio de Dermatología, Hospital Universitario Insular, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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Borrego" "autores" => array:1 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "Borrego" "email" => array:2 [ 0 => "lborregoh@meditex.es" 1 => "lborher@gobiernodecanarias.org" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Insular, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Lesiones cutáneas agudas tras intervenciones quirúrgicas. Aproximación clínica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0040" "etiqueta" => "Figure 8" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr8.jpeg" "Alto" => 750 "Ancho" => 1000 "Tamanyo" => 114244 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Lesions at the border of the tourniquet cuff. The tourniquet was protected with cotton wool and a bandage, which became impregnated with povidone iodine.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Interdepartmental Dermatology Consultations</span><p id="par0005" class="elsevierStylePara elsevierViewall">Interdepartmental consultations, including both the requests from other specialties for the dermatologic evaluation of patients and those made by dermatologists to colleagues in other specialties, form a very important part of dermatologic practice. The hospital is one of the main environments in which interdepartmental dermatologic consultations occur, usually in the form of a written consultation request.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> In this environment, one of the clinical problems that we may be asked to evaluate is that of a patient with inflammatory lesions after a surgical intervention.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p></span></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Analysis of the Problem</span><p id="par0010" class="elsevierStylePara elsevierViewall">Acute skin lesions that arise as a result of a surgical intervention can be of physical or chemical origin.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> Physical causes include burns and lesions due to traction, friction, or pressure, while the mechanisms underlying lesions produced by contact with a chemical product may be irritant or allergic. Finally, as in any hospitalized patient, the differential diagnosis must always include infections and drug reactions; the clinical correlates of such lesions differ from those of lesions arising during surgical procedures and do not fall within the scope of this article.</p><p id="par0015" class="elsevierStylePara elsevierViewall">A number of aspects must be taken into account in the initial evaluation of a patient with acute postsurgical skin lesions. The first is to determine the sequence of appearance of the lesions. It is not uncommon for patients to spend a significant time in the emergency room, where they may undergo limb traction or have prolonged contact with antiseptics or chemical debriding agents before the surgical intervention. We must also consider the possibility of lesions developing during the patient's stay in the postoperative recovery room, or that the lesions were present previously and the operation merely led the surgeon or nurse responsible for the patient to notice them. Finally, the patient may have developed similar lesions during other operations or following contact with other medical devices, which would suggest a possible allergic mechanism.</p><p id="par0020" class="elsevierStylePara elsevierViewall">For lesions that arise during a surgical intervention or in the immediate postoperative period, the first characteristics that we must evaluate are the site of the lesions, their morphology, and their relationship to the surgical wound. Lesions in dependent areas and signs of dropping figures would suggest a liquid has played a role (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), while an annular or rectangular morphology could suggest the electrocardiography pads or the dispersive electrode of an electrosurgical device (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Finally, lesions around the surgical incision may be due to antiseptics or to the dressings used before, during, or immediately after the operation.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Other factors that can affect the appearance of lesions are the use of occlusive plastic dressings (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), the antiseptic solution employed in the surgical field, and the care applied up to the time of consultation. All the procedures on the patient must be tracked from entering the surgical area until transfer to the ward. A record should also be made of the type and duration of the operation, the position in which the patient was placed for the intervention, and any changes to this position during the course of the procedure. If a burn is suspected, the use of an electrosurgical device and the electrical frequency employed must be evaluated. Sometimes it may even be necessary to take into consideration the antiseptics used to clean the operating table and surgical drapes. Finally, we must always determine whether the lesion is a sporadic event or if there are other patients with similar lesions.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Lesions of Physical Origin</span><p id="par0030" class="elsevierStylePara elsevierViewall">Lesions produced by heat are associated with the use thermal warming blankets and warming lamps. These are rare and may be due to poorly calibrated devices, a defect, or inappropriate use.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Such lesions occur in very long operations, as the skin surface can tolerate temperatures of 44<span class="elsevierStyleHsp" style=""></span>°C for up to 6<span class="elsevierStyleHsp" style=""></span>hours.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Other types of burns are caused by the electrosurgical device. A serious conflagration can occur if an electrical spark ignites intestinal gases or the vapor from alcohol-based antiseptic solutions.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> These 2 situations are very rare and are clearly surgeon-related.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Another type of thermal burn is one produced under the dispersive electrode of the electrosurgical device used in high-frequency mode. These lesions can develop when the electrode becomes impregnated with a fluid (blood, saline solution used for lavage, or antiseptic solution). Activation of the electrosurgical device causes the solution to vaporize, producing the burn.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,7</span></a> A further possible source of burns is disruption of the circuit of the electrical device used to produce hemostasis. When working with a high-frequency electrical device, a poorly or only partially adherent dispersive electrode will cause the current to run through a different site with less electrical resistance. In this situation, if the patient's skin is in contact with a material that offers low electrical resistance, such as areas of moisture or metallic objects, the current will flow through these points and may cause burns.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> The area of the sacrum, where liquid can collect during an operation, is a typical site for this to occur.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> These risks are higher in minimally invasive procedures, such as laparoscopy or endovascular catheterization (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> The possibility that the dispersive electrode has become detached from the skin, with the consequent increase in the risk of causing a burn, must be considered whenever the power of the electrosurgical device needs to be increased significantly during an intervention.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,10</span></a></p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Lesions due to prolonged pressure are very rare; they can develop in patients with arterial insufficiency and are similar to early pressure sores. Traction lesions are more common. These occur in patients undergoing orthopedic surgery, when dressings stuck directly onto the skin are used to hold a limb in traction. The shear force on the epidermis during removal of the adhesive dressing can produce blisters. A clinical finding that can help in the diagnosis of this type of lesion is that the dermatitis may be more marked around the follicles.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Although friction dermatitis is theoretically possible as a concept, it is more likely that the lesions are due to the antiseptic employed.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11,12</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Lesions Caused by Contact</span><p id="par0045" class="elsevierStylePara elsevierViewall">Inflammatory lesions in the postoperative period can be caused by contact with various substances. The mechanism of production of the lesions is usually irritant, but it may also be allergic. Irritant contact dermatitis is one of the most common causes of in-hospital interdepartmental dermatology consultations.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Preparation of the surgical field for the operation can alter the characteristics of the corneal layer, and this will facilitate the subsequent appearance of a dermatitis. Factors that favor the onset of acute irritant dermatitis during the operation include immobility, occlusion, maceration, the use of plastic dressings, a long surgical procedure, and the liberal use of antiseptics (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> and <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Progression along the established hospital pathway for patients undergoing surgical interventions can produce contact with 2 groups of irritant substances. First are the soaps and antiseptics used to clean the surgical table in the operating room and the stretchers for transfer; second are the antiseptics applied to the skin to prepare the surgical field. The antiseptics employed to clean operating room furniture and utensils are usually quaternary ammonium compounds, which are excellent disinfectants and are supplied for dilution in water to form soapy solutions. The irritant potential of most of these products on contact with the skin is well established and their instructions for use always indicate that direct contact with the skin should be avoided and that clinical material should be dried after cleaning with these disinfectants. However, these solutions are usually highly volatile, which reduces the risk of dermatitis. In the normal hospital pathway these substances cannot enter into contact with the skin, and cases of dermatitis will only arise when this pathway is in some way altered.</p><p id="par0050" class="elsevierStylePara elsevierViewall">It has been clearly demonstrated that the use of antiseptics to prepare the surgical field reduces the rate of intraoperative and surgical wound infections. All the substances employed have high germicidal activity and a marked irritant potential.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> They are usually applied to the surgical field and allowed to dry by evaporation or with the aid of a swab. However, when generous amounts of these substances are used, they remain in liquid form for a long period and can give rise to acute inflammatory lesions, particularly in dependent areas or beneath plastic dressings. Additional factors that produce occlusion, or the presence of damp swabs or drapes in contact with the patient's skin, increase the risk of irritant contact dermatitis.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Lesions that develop under these circumstances may not affect the surgical scar, which can lead to confusion as the physician may thus exclude antiseptics as the origin of the dermatitis.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14,15</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Although any antiseptic can cause acute irritant dermatitis if appropriate guidelines on application are not observed, povidone iodine is at present the antiseptic reported most commonly in the literature as a cause of this type of dermatitis.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,16–18</span></a> Povidone iodine is an iodophor formed of povidone, a very long-chain carbon polymer, complexed with iodine in equilibrium with the concentration of iodine in solution. Free iodine in the liquid phase has germicidal power and, as it is consumed, more iodine is released from the complex. Free iodine is irritant and, if it remains in liquid phase in contact with the skin for a long period, it can produce severe irritant lesions similar to burns or toxic epidermal necrolysis.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14,16,18–20</span></a> Four lesion patterns are recognized. The first and most specific is a pattern of parallel linear lesions in the lumbar region, caused by the accumulation of the antiseptic in lateral dependent areas during long procedures (<a class="elsevierStyleCrossRefs" href="#fig0025">Figs. 5–7</a>).<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> The second pattern develops when povidone iodine impregnates a terminal stuck to the patient, such as the electrocardiography monitoring electrodes or the dispersive electrode. In this case, the outline of the lesion mirrors the shape of the terminal; this must be differentiated from a possible allergic contact dermatitis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The third pattern occurs when the povidone impregnates the cotton wool or swabs used to protect the patient's skin from a physical device employed during the procedure. A characteristic lesion of this type is the one that develops along the border of the tourniquet cuff for limb operations. These cuffs are usually placed around the proximal part of the limb to block the blood flow (<a class="elsevierStyleCrossRef" href="#fig0040">Fig. 8</a>). Swabs and cotton wool are placed between the tourniquet and the skin; if these become impregnated with povidone iodine, lesions can develop at the borders of the cuff.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,11,12,21</span></a> The fourth recognized pattern is random and occurs in the dependent areas of the patient during the operation, with the appearance of runs caused by dripping of the liquid or impregnation of the surgical drapes (<a class="elsevierStyleCrossRef" href="#fig0045">Fig. 9</a>). As most operations are performed with the patient in the supine position, the lesions are found most commonly on the back, particularly in the sacral region.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> The differential diagnosis of postoperative inflammatory lesions in this area must include not only irritant dermatitis due to the antiseptic,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> but also burns caused by incorrect use of the electrosurgical device,<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,6</span></a> as has been commented above.</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia><elsevierMultimedia ident="fig0035"></elsevierMultimedia><elsevierMultimedia ident="fig0040"></elsevierMultimedia><elsevierMultimedia ident="fig0045"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">In addition to their irritant potential, antiseptics used to prepare the surgical field can cause allergic contact dermatitis.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22–24</span></a> In this case the area of the surgical incision is always affected and the appropriate investigations must then be performed, with patch testing to determine if the allergen is the antiseptic molecule itself, an excipient, or another substance that may have been in contact with the patient.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18,25–30</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">During a surgical intervention, the skin comes into contact with devices and substances that can cause allergic contact dermatitis in previously sensitized patients. Although contact dermatitis due to the nickel contained in medicosurgical instruments has been reported,<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">31–33</span></a> the alloys employed and the short period of contact during the procedure make it unlikely that lesions will be triggered by this hapten. As in all types of eczema, if a patient presents lesions in the area of contact with an object, appropriate evaluation must be performed in a contact dermatitis unit.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">27,28,30</span></a> Lesions that occur in the area of the dispersive electrode of an electrosurgical device or of pacemaker electrodes can be caused not only by the irritant properties of the adhesive, aggravated or not by the antiseptic employed, but also by sensitization to any of the components of the electrode or to the gels used to increase the electrical conductivity of the skin.<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">30,34</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">Although mild skin complications after surgical interventions have not been extensively studied, they can be relatively common. The lesions are usually transitory and are typically assumed to be inherent to the surgical procedure, both by the patient and by the medical staff.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Even when these lesions are mild, they should be investigated and diagnosed to prevent more serious harm in the future, if the same situation arises with additional concomitant factors. However, the in-depth study of cases is usually difficult, as health staff adopt a defensive approach to any investigation that may be required. Most of the lesions occur due to an inappropriate use of the substances or devices employed and they are very rarely due to allergy or defective material.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,6,16</span></a> It is our duty as physicians to draw attention to the possible incorrect use of medical materials, thus helping to establish appropriate guidelines. A basic rule that would prevent many complications would be to ensure that the antiseptic solution dries completely before the surgical procedure is started.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4,6,8</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Adequate collaboration with our colleagues not only offers an opportunity to improve the quality of patient care, but will also bring credit to our specialty in the hospital environment.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Ethical Disclosures</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Protection of human and animal subjects</span><p id="par0080" class="elsevierStylePara elsevierViewall">The author declares that no experiments were performed on humans or animals for this investigation</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Confidentiality of data</span><p id="par0085" class="elsevierStylePara elsevierViewall">The author declares that he has followed his hospital's protocol on the publication of data concerning patients and that all patients included in the study have received sufficient information and have given their written informed consent to participate in the study.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Right to privacy and informed consent</span><p id="par0090" class="elsevierStylePara elsevierViewall">The author declares that no private patient data are disclosed in this article.</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conflicts of Interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">The author declares that he has no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:2 [ "identificador" => "xres285032" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec268273" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres285031" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec268274" "titulo" => "Palabras clave" ] 4 => array:3 [ "identificador" => "sec0005" "titulo" => "Introduction" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Interdepartmental Dermatology Consultations" ] ] ] 5 => array:2 [ "identificador" => "sec0015" "titulo" => "Analysis of the Problem" ] 6 => array:2 [ "identificador" => "sec0020" "titulo" => "Lesions of Physical Origin" ] 7 => array:2 [ "identificador" => "sec0025" "titulo" => "Lesions Caused by Contact" ] 8 => array:2 [ "identificador" => "sec0030" "titulo" => "Discussion" ] 9 => array:3 [ "identificador" => "sec0035" "titulo" => "Ethical Disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0050" "titulo" => "Right to privacy and informed consent" ] ] ] 10 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflicts of Interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-12-27" "fechaAceptado" => "2013-04-07" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec268273" "palabras" => array:4 [ 0 => "Surgery" 1 => "Povidone iodine" 2 => "Chemical burn" 3 => "Contact dermatitis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec268274" "palabras" => array:4 [ 0 => "Cirugía" 1 => "Povidona yodada" 2 => "Quemadura química" 3 => "Dermatitis de contacto" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">In the hospital setting, dermatologists are often required to evaluate inflammatory skin lesions arising during surgical procedures performed in other departments. These lesions can be of physical or chemical origin. Povidone iodine is the most common reported cause of such lesions. If this antiseptic solution remains in contact with the skin in liquid form for a long period of time, it can give rise to serious irritant contact dermatitis in dependent or occluded areas. Less common causes of skin lesions after surgery include allergic contact dermatitis and burns under the dispersive electrode of the electrosurgical device. Most skin lesions that arise during surgical procedures are due to an incorrect application of antiseptic solutions. Special care must therefore be taken during the use of these solutions and, in particular, they should be allowed to dry.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dentro del ámbito hospitalario no es infrecuente que los dermatólogos debamos valorar lesiones cutáneas inflamatorias que surgen en intervenciones quirúrgicas realizadas por otros servicios. Estas lesiones pueden ser de causa física o química. La povidona yodada es la causa descrita más frecuentemente de aparición de estas lesiones. Este antiséptico, si permanece en solución en contacto con la piel durante un periodo prolongado, puede ocasionar dermatitis irritativas graves en zonas declives u ocluidas. Otras causas menos frecuentes son dermatitis alérgicas de contacto o quemaduras en el terminal de toma de tierra del bisturí eléctrico. Debido a que la mayor parte de estas lesiones se debe a una aplicación incorrecta del antiséptico, deben extremarse sus normas de uso, especialmente dejándolo secar de forma adecuada.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Borrego L. Lesiones cutáneas agudas tras intervenciones quirúrgicas. Aproximación clínica. Actas Dermosifiliogr. 2013;104:776–781.</p>" ] ] "multimedia" => array:9 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 750 "Ancho" => 1000 "Tamanyo" => 112845 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Images of dropping figures suggesting a fluid as possible cause of the dermatitis.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 651 "Ancho" => 1000 "Tamanyo" => 76057 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Annular and rectangular lesions corresponding to an electrocardiography electrode and the dispersive electrode of the electrosurgical device.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 750 "Ancho" => 1000 "Tamanyo" => 144174 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Disjointed areas of inflammation in a patient in whom the surgical field was covered with an occlusive plastic drape and who underwent the operation in a semirecumbent position.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 773 "Ancho" => 1000 "Tamanyo" => 98217 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Thermal burn on the buttocks after laparoscopy.</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1000 "Ancho" => 1000 "Tamanyo" => 275720 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Photograph taken immediately prior to covering the patient with the surgical drapes. Observe the accumulation of antiseptic on the lateral wall of the trunk. Photograph courtesy of the General Surgery Department.</p>" ] ] 5 => array:7 [ "identificador" => "fig0030" "etiqueta" => "Figure 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 1100 "Ancho" => 731 "Tamanyo" => 124262 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Parallel lesions in the lumbar region after the application of povidone iodine antiseptic prior to colectomy.</p>" ] ] 6 => array:7 [ "identificador" => "fig0035" "etiqueta" => "Figure 7" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr7.jpeg" "Alto" => 1250 "Ancho" => 1667 "Tamanyo" => 166552 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Image demonstrating the accumulation of antiseptic in the lumbar region in patients undergoing operation in the supine position.</p>" ] ] 7 => array:7 [ "identificador" => "fig0040" "etiqueta" => "Figure 8" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr8.jpeg" "Alto" => 750 "Ancho" => 1000 "Tamanyo" => 114244 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Lesions at the border of the tourniquet cuff. The tourniquet was protected with cotton wool and a bandage, which became impregnated with povidone iodine.</p>" ] ] 8 => array:7 [ "identificador" => "fig0045" "etiqueta" => "Figure 9" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr9.jpeg" "Alto" => 750 "Ancho" => 1000 "Tamanyo" => 99264 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Irritant lesions caused by povidone iodine on the anterior chest wall in a patient operated in the prone position for lumbar arthrodesis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:34 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Contact dermatitis in hospital patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 35 | 14 | 49 |
| 2024 October | 285 | 51 | 336 |
| 2024 September | 384 | 38 | 422 |
| 2024 August | 393 | 55 | 448 |
| 2024 July | 318 | 30 | 348 |
| 2024 June | 260 | 35 | 295 |
| 2024 May | 271 | 42 | 313 |
| 2024 April | 233 | 23 | 256 |
| 2024 March | 280 | 42 | 322 |
| 2024 February | 399 | 35 | 434 |
| 2024 January | 310 | 41 | 351 |
| 2023 December | 378 | 35 | 413 |
| 2023 November | 421 | 32 | 453 |
| 2023 October | 470 | 24 | 494 |
| 2023 September | 479 | 37 | 516 |
| 2023 August | 368 | 21 | 389 |
| 2023 July | 367 | 36 | 403 |
| 2023 June | 276 | 31 | 307 |
| 2023 May | 203 | 22 | 225 |
| 2023 April | 247 | 23 | 270 |
| 2023 March | 164 | 23 | 187 |
| 2023 February | 200 | 25 | 225 |
| 2023 January | 157 | 25 | 182 |
| 2022 December | 112 | 55 | 167 |
| 2022 November | 110 | 36 | 146 |
| 2022 October | 82 | 22 | 104 |
| 2022 September | 88 | 47 | 135 |
| 2022 August | 86 | 36 | 122 |
| 2022 July | 111 | 50 | 161 |
| 2022 June | 66 | 28 | 94 |
| 2022 May | 140 | 46 | 186 |
| 2022 April | 163 | 43 | 206 |
| 2022 March | 136 | 61 | 197 |
| 2022 February | 157 | 27 | 184 |
| 2022 January | 157 | 37 | 194 |
| 2021 December | 95 | 33 | 128 |
| 2021 November | 104 | 51 | 155 |
| 2021 October | 149 | 70 | 219 |
| 2021 September | 99 | 56 | 155 |
| 2021 August | 85 | 52 | 137 |
| 2021 July | 87 | 44 | 131 |
| 2021 June | 92 | 44 | 136 |
| 2021 May | 83 | 40 | 123 |
| 2021 April | 194 | 89 | 283 |
| 2021 March | 124 | 31 | 155 |
| 2021 February | 60 | 38 | 98 |
| 2021 January | 56 | 30 | 86 |
| 2020 December | 55 | 29 | 84 |
| 2020 November | 48 | 16 | 64 |
| 2020 October | 67 | 14 | 81 |
| 2020 September | 55 | 17 | 72 |
| 2020 August | 37 | 24 | 61 |
| 2020 July | 57 | 12 | 69 |
| 2020 June | 50 | 25 | 75 |
| 2020 May | 59 | 22 | 81 |
| 2020 April | 53 | 17 | 70 |
| 2020 March | 145 | 13 | 158 |
| 2020 February | 3 | 0 | 3 |
| 2020 January | 4 | 1 | 5 |
| 2019 December | 8 | 3 | 11 |
| 2019 November | 4 | 3 | 7 |
| 2019 October | 0 | 2 | 2 |
| 2019 September | 5 | 2 | 7 |
| 2019 August | 7 | 0 | 7 |
| 2019 July | 4 | 1 | 5 |
| 2019 June | 6 | 11 | 17 |
| 2019 May | 7 | 13 | 20 |
| 2019 April | 2 | 5 | 7 |
| 2019 March | 4 | 7 | 11 |
| 2019 February | 2 | 0 | 2 |
| 2019 January | 2 | 0 | 2 |
| 2018 December | 3 | 0 | 3 |
| 2018 November | 2 | 0 | 2 |
| 2018 October | 6 | 1 | 7 |
| 2018 September | 2 | 1 | 3 |
| 2018 August | 0 | 1 | 1 |
| 2018 July | 0 | 2 | 2 |
| 2018 June | 0 | 8 | 8 |
| 2018 May | 0 | 7 | 7 |
| 2018 April | 0 | 5 | 5 |
| 2018 March | 9 | 4 | 13 |
| 2018 February | 83 | 3 | 86 |
| 2018 January | 103 | 10 | 113 |
| 2017 December | 76 | 12 | 88 |
| 2017 November | 85 | 6 | 91 |
| 2017 October | 70 | 12 | 82 |
| 2017 September | 79 | 11 | 90 |
| 2017 August | 83 | 11 | 94 |
| 2017 July | 85 | 8 | 93 |
| 2017 June | 83 | 13 | 96 |
| 2017 May | 85 | 11 | 96 |
| 2017 April | 82 | 17 | 99 |
| 2017 March | 81 | 35 | 116 |
| 2017 February | 64 | 9 | 73 |
| 2017 January | 71 | 22 | 93 |
| 2016 December | 158 | 16 | 174 |
| 2016 November | 211 | 14 | 225 |
| 2016 October | 212 | 21 | 233 |
| 2016 September | 250 | 7 | 257 |
| 2016 August | 248 | 6 | 254 |
| 2016 July | 111 | 11 | 122 |
| 2016 June | 14 | 18 | 32 |
| 2016 May | 10 | 12 | 22 |
| 2016 April | 8 | 3 | 11 |
| 2016 March | 6 | 3 | 9 |
| 2016 February | 12 | 1 | 13 |
| 2016 January | 14 | 2 | 16 |
| 2015 December | 7 | 7 | 14 |
| 2015 November | 6 | 10 | 16 |
| 2015 October | 7 | 2 | 9 |
| 2015 September | 5 | 2 | 7 |
| 2015 August | 5 | 2 | 7 |
| 2015 July | 182 | 12 | 194 |
| 2015 June | 93 | 7 | 100 |
| 2015 May | 78 | 9 | 87 |
| 2015 April | 97 | 5 | 102 |
| 2015 March | 150 | 7 | 157 |
| 2015 February | 155 | 2 | 157 |
| 2015 January | 112 | 1 | 113 |
| 2014 December | 208 | 4 | 212 |
| 2014 November | 256 | 4 | 260 |
| 2014 October | 587 | 19 | 606 |
| 2014 September | 579 | 5 | 584 |
| 2014 August | 73 | 12 | 85 |
| 2014 July | 102 | 4 | 106 |
| 2014 June | 94 | 4 | 98 |
| 2014 May | 108 | 12 | 120 |
| 2014 April | 87 | 9 | 96 |
| 2014 March | 91 | 6 | 97 |
| 2014 February | 82 | 7 | 89 |
| 2014 January | 48 | 3 | 51 |
| 2013 December | 33 | 13 | 46 |
| 2013 November | 22 | 9 | 31 |
| 2013 October | 2 | 4 | 6 |
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