How is diabetes mellitus addressed during the dermatologic preoperative evaluation and management?

Updated: Mar 16, 2020
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Answer

Patients with poorly controlled diabetes may have adverse wound healing and an increased propensity toward infections because of defects in chemotaxis, opsonization, and phagocytosis. This becomes critical when areas of microvascularization, such as the digits, are the proposed sites of surgery. Additionally, the high prevalence of microangiopathy in the skin and peripheral neuropathy make wound healing in acral sites more difficult in this population. The physician may administer postoperative antibiotics to avoid potential wound infections and may use epinephrine with caution. Given the high potential risk of perioperative wound infections, several authors recommend the use of prophylactic antibiotics in patients with diabetes. Ideally, the patient's blood glucose level should be fairly controlled, and the insulin doses should be adjusted as needed. Management of hypoglycemic agents and different types of insulin can be pivotal. [2]


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