Surgical Site Infections in Dermatologic Surgery- Clinical, diagnostic, and pathogenic aspects

Abstract: Surgical site infections (SSIs) in dermatologic surge- ry contribute to unwanted healthcare costs and are complications that cause su ering in patients. The aim of this thesis was to explore clinical, diagnos- tic, and pathogenic aspects of SSIs in dermatologic surgery.In study I, we examined bacterial dynamics during normal wound healing and SSIs. We found that quantifying bacteria from wounds was a relevant factor for assessing healing outcomes. Higher bac- terial loads in wounds resulted in complicated post- operative healing outcomes.In study II, we designed a randomized controlled trial exploring the e ects of a novel antiseptic, po- lyhexanide biguanide (PHMB) on bacterial loads. PHMB added to tie-over dressings in full-thickness skin grafting did not decrease bacterial loads and paradoxically increased the incidence of SSIs in the intervention group.In study III, we examined whether wound uids obtained from dermatosurgical wounds could pre- dict the occurrence of an SSI. Our results showed that the investigated biomarkers could indeed ser- ve as diagnostics for assessing wound healing.In study IV, the aim of the study was to assess in- ter-observer agreement when assessing wound healing in dermatologic surgery. There was a bro- ad inter-observer variability in the diagnosis of an SSI illustrating the need for objective diagnostic methods that capture an actual SSI.Ultimately, we provided new insights into SSIs in dermatologic surgery that can be useful in discove- ring methods to prevent these types of infections in the future.Keywords: Surgical site infections (SSIs), derma- tologic surgery, full-thickness skin grafting, acute wounds, wound healing, microbiome, diagnostics, prevention, pathogenesis.