When Cosmetic Procedures Go Wrong: Wounded Skin Emergencies
Overview
This study aimed to assess the occurrence of emergency complications among dermatologists during dermatological, surgical, and cosmetic procedures, as well as their knowledge of emergency protocols and basic life support. Conducted through an online survey of 240 dermatologists, the study examined the frequency of such complications and evaluated the respondents’ preparedness.
Results revealed that 53% of dermatologists encountered emergency complications during dermatological and surgical procedures, and 43.2% during cosmetic procedures. Common issues included vasovagal syncope, hypotension/bleeding, and seizures. Complications were more prevalent among specialists, those with over 15 years of experience, those practicing in private clinics, and those performing 10–50 dermatological/surgical procedures weekly, with fewer than 10 cosmetic procedures per week (p < 0.05).
Knowledge of emergency protocols was notably higher among dermatology residents, those with 0–4 years of experience, those employed at university hospitals, and those with both theoretical and practical training in basic life support.
In conclusion, while emergency complications are relatively frequent, they are generally mild and self-limiting. It is crucial for dermatologists to be well-prepared and proficient in managing medical emergencies as part of their routine practice.
Introduction
Medical emergencies, which involve critical and potentially life-threatening conditions requiring immediate intervention, are increasingly relevant in dermatology due to the rising use of local anesthesia in dermatological and cosmetic procedures. The integration of local anesthesia into these practices has led to a greater need for awareness and preparedness in handling emergencies that may arise. Common emergencies in dermatology include vasovagal syncope, which is a sudden drop in heart rate and blood pressure leading to fainting; anaphylaxis, a severe allergic reaction that can cause airway obstruction and shock; hyperventilation syndrome, characterized by rapid and shallow breathing leading to dizziness and tingling; and cardiac arrest, where the heart suddenly stops beating effectively.
Early recognition and prompt intervention are essential in managing these emergencies effectively and potentially saving lives. However, there is a significant concern that many dermatologists may not feel sufficiently prepared to handle such situations, despite their increasing relevance. This gap highlights the need for enhanced training and preparedness in emergency response.
There is a notable lack of comprehensive understanding regarding the frequency and nature of these emergencies within dermatological practice. Additionally, there is limited data on dermatologists’ knowledge and preparedness for emergency response and basic life support. While dermatological surgeries and cosmetic procedures are generally considered safe, the occurrence of emergency complications is not frequently addressed in the existing literature.
This study aims to bridge this gap by investigating the incidence of emergency situations encountered by dermatologists in their daily practice, including during dermatological, surgical, and cosmetic procedures. It will also assess the level of competence among dermatologists in managing emergencies and providing basic life support. By understanding these factors, the study seeks to enhance awareness, improve training, and ultimately ensure better preparedness among dermatologists for handling emergencies.
Method
This cross-sectional descriptive study, conducted from December 1, 2022, to January 31, 2023, employed a 33-item web-based questionnaire to gather data. The questionnaire was distributed through email and a closed social media group managed by the Turkish Society of Dermatology. The study received local ethics committee approval, and participants provided informed consent online.
The questionnaire was structured into four distinct sections:
1. Sociodemographic and Occupational Details: This section collected information about the demographic characteristics and professional background of the dermatologists.
2. Procedural Practices: It assessed the types and frequencies of dermatological, surgical, and cosmetic procedures performed by the participants.
3. Emergency Complications: This section investigated the occurrence of emergency complications during these procedures, including vasovagal syncope, seizures, anaphylaxis, hyperventilation syndrome, hypotension/bleeding, and cardiac arrest.
4. Knowledge of Emergency Protocols: It evaluated the dermatologists’ knowledge of emergency complications and basic life support procedures.
Data analysis was conducted using SPSS Statistics for Windows, version 21.0. Continuous data were summarized with means ± standard deviations for normally distributed data and medians with interquartile ranges for non-normally distributed data. Categorical data were expressed as percentages. The Mann-Whitney U test was applied for comparing two groups of non-normally distributed data, while one-way ANOVA was used for comparing three or more groups. Tukey’s multiple comparison test further analyzed significant differences, and Pearson’s exact chi-squared test was employed for cross-table analysis. Statistical significance was determined with a p-value of less than 0.05, and results were interpreted within a 95% confidence interval.
Result
The study involved 240 dermatologists, with an average age of 40.27 years and 81% being female. Key findings regarding emergency complications during dermatological and surgical procedures showed that 53% of the dermatologists reported such issues. The most frequently encountered complications were vasovagal syncope (58%), hypotension/bleeding (28%), and seizures (10%). These complications were most common during biopsies (34%) and intralesional injections (27%), predominantly affecting the head and neck region (50%).
Among the 194 dermatologists performing cosmetic procedures, 43.2% experienced emergency complications. The leading complications in this group were vasovagal syncope (38.6%), hypotension/bleeding (13.9%), and seizures (5.6%), occurring most frequently during dermal filler injections (23.7%) and botulinum toxin injections (17%).
Training in basic life support varied among participants: 27% had no training, 31% had theoretical training only, and 42% had both theoretical and practical training. Emergency complications were notably more frequent among specialists, those with over 15 years of experience, those working in private clinics, and those conducting 10-50 procedures per week, with fewer cosmetic procedures being performed weekly.
Regarding self-assessed knowledge and skills on emergency complications, 47% rated themselves as fair, 30% as poor, 2% as very poor, 18% as good, and 3% as very good. Knowledge scores were higher among residents, dermatologists with 0-4 years of experience, those working in university hospitals, and those with comprehensive basic life support training.
A significant majority (95%) of dermatologists expressed interest in participating in additional training programs on emergency complications and basic life support.
Conclusion
The study highlights that 53% of dermatologists encountered emergency complications during dermatological and surgical procedures, while 43.2% reported such issues during cosmetic procedures. Complication rates were notably higher for dermatological and surgical procedures compared to cosmetic ones. This discrepancy may be attributed to patients’ heightened concern about aesthetic outcomes in cosmetic procedures, potentially leading to fewer complications such as vasovagal syncope, which occurred in 38.6% of cosmetic procedures versus 58% in dermatological/surgical procedures. Additionally, patients undergoing cosmetic procedures are often healthier, unlike those undergoing dermatological or surgical procedures who may have underlying medical conditions that increase complication risk.
In the U.S., Hazen et al. documented 55 emergency events over 565 physician-years, with more frequent emergencies reported during medical procedures than surgical ones. The study also examined factors such as dermatologists’ experience and practice settings, finding that specialists with over 15 years of experience, those in private practice, and those performing a high volume of dermatological/surgical procedures reported more complications. This could be due to their greater exposure and experience with such complications.
The most frequently reported emergencies in the study were vasovagal syncope, hypotension/bleeding, and seizures. Comparatively, other studies have reported lower complication rates. For instance, a French study found a 6% complication rate, while Mohs micrographic surgery had a 1.6% complication rate. Variations in study methodologies might account for these differences.
The study also identified anaphylaxis as a rare but severe complication, occurring in 3% of cases, with management including prompt administration of adrenaline. Hyperventilation syndrome, another less common issue, was reported by 3% of dermatologists, with half correctly identifying appropriate management techniques.
Cardiac arrest was reported by a small percentage of dermatologists (0.8% in dermatological/surgical and 0.5% in cosmetic procedures), emphasizing the importance of preparedness for such critical events. Despite its rarity, effective management involves basic life support and defibrillation.
Dermatologists generally displayed adequate knowledge about managing emergencies, though a substantial proportion expressed interest in further training. Notably, residents and those with recent training had higher levels of emergency knowledge. The study advocates for regular refresher courses in basic life support and emergency management for dermatologists.
The study’s limitations include its cross-sectional design, reliance on self-reported data, and potential biases due to its online format. Despite these limitations, the findings underscore that while emergency complications in dermatology are relatively frequent, most are manageable and not life-threatening. Continued education and preparedness are essential for maintaining patient safety during dermatological procedures.
Oncology Related Tools
Other
Latest Research
