Mohs Micrographic Surgery Safe and Effective Perioperative Care

Function

Initial Evaluation

The initial evaluation for MMS involves a detailed assessment of the patient and the tumor to determine the appropriateness of the procedure.[3] The American Academy of Dermatology and other organizations have developed appropriate use criteria to assist clinicians in selecting suitable candidates for MMS.[1] The appropriate use criteria classify the body into 3 areas based on the need for tissue preservation in MMS:

• Area H
  • This area includes the central face (eyelids, nose, lips, chin), ears, genitalia, hands, feet, nails, ankles, and nipples—regions where tissue preservation is critical, making MMS highly appropriate.[5] 
• Area M
  • This area encompasses the cheeks, forehead, scalp, neck, jawline, and pretibial surface, where the decision for MMS depends on additional tumor and patient characteristics.[5]
• Area L
  • This area covers the trunk and extremities, excluding the pretibial surface, hands, feet, nails, and ankles, with the suitability for MMS determined by specific factors related to the tumor and the patient.[5] 

MMS is typically indicated for tumors at a high risk of recurrence, those found in cosmetically or functionally sensitive areas, those with poorly defined borders, large malignancies, or those with aggressive histologic features.[3] Patients with immunosuppression, those who have genetic predispositions to skin cancer, or those with tumors in previously irradiated or chronically inflamed skin are also considered good candidates for MMS.[5] The successful application of MMS relies on the contiguous growth pattern of the tumor, ensuring that this tissue can be effectively excised layer by layer under microscopic guidance. Additionally, patients must be able to tolerate the procedure under only local anesthesia, often with only minimal oral anxiolysis.[3]

Safety

MMS is widely regarded as a safe procedure, primarily performed under local anesthesia, which avoids the risks associated with general anesthesia and is overall well-tolerated even by patients considered poor candidates for more invasive surgeries.[1] Results from a 23-center prospective study showed that adverse events following MMS are rare, with minor complications occurring in just 0.72% of cases and severe adverse effects in only 0.02%.[1] The most common complications included infections, bleeding, and impaired wound healing, typically managed effectively by Mohs surgeons in their offices, minimizing the need for additional healthcare resources. Hospital admissions were exceedingly rare, occurring in only 0.02% of all procedures, with no cases of permanent disability or death reported.[1] Most tumors treated with MMS are removed in 1 or 2 stages, and primary closure, commonly used for wound repair, results in fewer complications and lower postoperative pain, contributing to high patient satisfaction with the procedure.[1]

Antibiotic Use

Antibiotic use in MMS is a nuanced decision guided by patient-specific risk factors and the type of procedure being performed. Surgical site infections are relatively rare in MMS, with infection rates typically ranging from 1.4% to 2.7%, depending on factors such as the anatomic site and closure method.[6] However, certain conditions and patient characteristics can increase the risk of infection. Patients with diabetes, those who are immunosuppressed, those undergoing surgeries on the lower extremities, or those having complex closure techniques such as flaps or grafts are at a higher risk and may benefit from prophylactic antibiotics.[6] The use of antibiotics in MMS also extends to preventing endocarditis and prosthetic joint infections in high-risk patients.[6] The American Heart Association recommends prophylactic antibiotics for patients with prosthetic heart valves, a history of endocarditis, certain congenital heart defects, and those who have undergone recent joint replacement surgery.[5]

The American Heart Association recommends administering prophylactic antibiotics 30 to 60 minutes before a procedure, while the American Dental Association and American Academy of Orthopedic Surgeons suggest a full 60 minutes. For dermatologic surgical antibiotic prophylaxis involving nonoral sites, cephalexin or dicloxacillin 2 grams is typically recommended, with clindamycin 600 milligrams or azithromycin 500 milligrams as alternatives for patients with penicillin allergies.[6] In cases where patients cannot tolerate oral medications, cefazolin or ceftriaxone 1 gram may be administered intramuscularly or intravenously, or clindamycin 600 milligrams intramuscularly or intravenously for penicillin-allergic patients.[6] 

If the surgical site involves infected skin, antibiotics should be tailored based on the organism's susceptibilities and the patient's medication allergies. For procedures breaching the oral mucosa, amoxicillin 2 grams is recommended for patients without penicillin allergies, with clindamycin 600 milligrams or azithromycin 500 milligrams as alternatives.[6] The most common organisms responsible for cutaneous surgical site infections include Staphylococcus aureus, coagulase-negative staphylococci, enterococci, Escherichia coli, Pseudomonas aeruginosa, and Enterobacter species.[6] First-line agents for cutaneous infections typically include penicillins and cephalosporins, with alternatives for methicillin-resistant Staphylococcus aureus if a resistant strain is suspected.[6]

Antibiotic prophylaxis is considered more frequently to mitigate the risk of severe infections that could lead to poor cosmetic outcomes or other complications for cases involving infected skin or high-risk anatomic sites such as the nasal flaps, anogenital region, or lower extremities.[7] Despite the low overall risk of surgical site infection, the potential consequences in cosmetically sensitive areas necessitate carefully considering antibiotic use. Furthermore, antibiotic stewardship is essential to minimize the risks of drug reactions, allergies, and the growing concern of antimicrobial resistance, ensuring that antibiotics are used judiciously and only when necessary.[6] The decision to use antibiotics in MMS should balance the low risk of infection with the individual patient's risk factors and the potential benefits and harms of prophylaxis.[6] This careful approach helps to optimize patient outcomes while maintaining adherence to best practices in antibiotic stewardship.

Anticoagulants

Before MMS, discussing whether to continue or discontinue anticoagulation medications is essential. Generally, patients with a history of thrombotic events are advised to continue their anticoagulants, as discontinuing them can lead to serious thrombotic events, including impairment or death.[1] For patients on anticoagulants for primary prevention, the decision to continue or stop the medication should be made in consultation with the primary care clinician, considering the risks of bleeding versus thrombotic events.[1] In most cases, medically necessary anticoagulants are continued during MMS, as bleeding complications are rare and can be effectively managed with techniques like electrodesiccation and pressure bandages.[5] 

Particular caution is advised for patients on medications like clopidogrel and warfarin, where achieving intraoperative hemostasis is crucial, and preoperative monitoring of coagulation levels may be warranted.[5] A prothrombin time and international normalized ratio (INR) should be checked 1 week before surgery for patients taking warfarin. If the INR is above the therapeutic range, surgery should be postponed.[5] Bruton tyrosine kinase inhibitors, which are medications used for lymphoma and leukemia, have a blood thinning effect and should be temporarily discontinued with the approval of their oncologist before dermatologic surgical procedures.[8]

Implantable Devices

Before performing MMS on patients with pacemakers, implantable cardioverter defibrillators, or other implantable devices, special precautions are necessary to prevent device malfunction due to electromagnetic interference from electrosurgery.[1] Study results have shown that hyfrecators can be used safely at a minimum distance of 3 cm from newer pacemakers at maximum settings or 1 cm at standard settings, with no documented complications in patients with these devices during MMS.[5] For patients with deep brain stimulators, heat electrocautery is preferred for the lowest risk of any interference, but bipolar electrosurgery may also be considered.[9] In patients with cochlear implants, mono- and biterminal electrosurgery should only be used below the clavicles, with electrocautery as the ideal option for immediate hemostasis.[9] 

Nerve stimulators, such as those for the vagal, sacral, and phrenic nerves and spinal cord stimulators, are susceptible to electromagnetic interference during electrosurgery, which may cause injury if not managed properly.[9] Sacral and spinal cord stimulators can be temporarily deactivated during procedures, and electrocautery should be avoided while these devices are active.[9] However, turning off vagal nerve stimulators for epilepsy or phrenic nerve stimulators for ventilatory support is less feasible and not recommended.[9] For these patients, it is advised to position the current path away from the device to minimize electromagnetic interference risk, use bipolar rather than monopolar units, and employ heat cautery when possible.[9] Careful planning and consultation with the patient's cardiologist or neurologist are essential to ensure the safe use of electrosurgery in these scenarios.

Preoperative Considerations

Preoperative considerations for MMS are crucial to ensure patient safety and optimal surgical outcomes. Identifying the correct surgical site is essential, as wrong-site surgery is a common cause of legal action against dermatologic surgeons.[3] Utilizing photographs taken during the biopsy is a best practice to avoid such errors.[3] Additionally, preoperative photography and documentation can help illustrate and record any existing asymmetries, scars, or anatomic irregularities, which can prevent the misattribution of these features to the surgical procedure.[3] Preoperative assessments, including imaging, are vital to evaluate potential bony or perineural invasion, ensuring that all aspects of the patient's condition are addressed.[10]

MMS is typically performed as an outpatient procedure under local anesthesia, and careful preoperative medical record review is necessary. Key considerations include antibiotic prophylaxis, management of implantable devices to avoid interference with electrosurgery, human immunodeficiency and hepatitis C viral status, oxygen requirements, and verification of all prescription and nonprescription medications.[5] Patients should be screened for all allergies, especially latex, which can cause severe hypersensitivity reactions.[11]

Obtaining informed consent and counseling patients about the surgical plan, potential risks, and expected outcomes are essential in the preoperative process. This step ensures that patients are fully aware of the procedure and can address concerns beforehand.[3] Before injecting local anesthesia, it is vital to mark anatomic landmarks, as the edema from anesthesia can obscure these landmarks and complicate surgical planning.[3]

Management of comorbidities is also crucial before surgery, as these can affect wound healing and may require adjustments to perioperative care. While dermatologic surgery is classified as a low-risk cardiac procedure, patients with active cardiac conditions, such as recent myocardial infarction, unstable angina, or decompensated heart failure, should undergo further cardiovascular evaluation before proceeding with surgery.[12] Measuring blood pressure before surgery is recommended to determine if surgery should be deferred due to the risk of excessive bleeding and stroke if a patient's blood pressure is significantly elevated.[12]

Communication with the patient’s other clinicians is essential for coordinating care, particularly when managing anticoagulation or implantable devices.[5] Behavioral modifications, such as smoking and alcohol reduction, can also help minimize complications both during and after surgery. Ideally, patients should discontinue tobacco use 1 to 2 weeks before and after surgery.[5] Finally, postoperative care planning, including pain management and follow-up, should be considered during the preoperative phase to set patient expectations and ensure continuity of care.[5] These comprehensive preoperative preparations help minimize risks and optimize surgical outcomes for patients undergoing MMS.

Perioperative Considerations

MMS is typically performed as a clean procedure using sterile instruments in a clinical setting with nonsterile gloves and clean drapes. Surgeons usually prepare by handwashing or using alcohol-based hand sanitizers, and the surgical site is treated with antiseptics like chlorhexidine gluconate or povidone-iodine.[3] Povidone-iodine must dry completely to be effective, as it becomes inactivated by blood. Chlorhexidine should be used cautiously around the eyes and ears due to the potential risks of keratitis and ototoxicity, similar to alcohol. Hydrogen peroxide can cause irritation, redness, and complications like temporary corneal damage.[13] 

Infection rates for MMS are low, ranging from less than 1% to 3.5%, but rigorous infection-control practices can further reduce these rates.[14] Implementing enhanced sterility protocols, such as alcohol hand scrub, sterile gloves, gowns, and towels, significantly lowers infection rates from 2.5% to 0.9%.[14] Most study respondents used chlorhexidine to clean surgical sites preoperatively, with povidone-iodine preferred for periocular and ear areas.[15] The debate over using sterile versus nonsterile gloves during the tumor extirpation phase of MMS is ongoing. Some study results have reported higher infection risks with nonsterile gloves, particularly during reconstructive procedures, while others found no significant difference in infection rates. However, using sterile gloves as part of an enhanced infection-control regimen has been associated with lower infection rates and improved hand hygiene compliance and, therefore, is typically implemented.[14]

Local anesthetics, primarily lidocaine with epinephrine, are used for pain control and hemostasis during MMS. The ideal local anesthetic for skin surgery should be fast-acting, long-lasting, and minimize patient discomfort.[16] Ropivacaine, a local anesthetic with a long duration of action without epinephrine, lasts 2 to 3 hours.[16] Other long-acting anesthetics include tetracaine and etidocaine.[16] In contrast, the shortest-acting agents are procaine and chloroprocaine, which last about 15 to 30 minutes, followed by lidocaine, mepivacaine, and prilocaine, which provide anesthesia for 30 to 90 minutes.[16] Dermatologic surgeons typically use lidocaine (0.5%, 1%, or 2%) with epinephrine, which is adequate for most procedures.

However, MMS, which can be prolonged and involve multiple stages, often requires reinjections of lidocaine. While serum toxicity levels are not usually reached, repeated injections can increase patient anxiety and negatively impact their perception of the procedure.[16] For extended anesthetic effects, adjunctive use of bupivacaine with epinephrine can reduce the need for repeated lidocaine injections, improving patient comfort.[16] Bupivacaine is more acidic, lipid-soluble, and has a longer duration of action compared to lidocaine, but it is much more expensive.[16] In addition, it is more painful to inject because of its low pH and inability to be buffered with sodium bicarbonate.[16] Because of these reasons, bupivacaine is not considered first-line.[16]

Patients undergoing wide surgical excisions for MMS can require large volumes of local anesthetic, especially those aged 65 and older with comorbidities requiring blood thinners. A modified formulation of lidocaine and epinephrine has recently been shown to provide adequate anesthesia and hemostasis, particularly for surgeries on the scalp or in patients on blood thinners.[17] This formulation, which consists of a 1-mm single-dose ampule of 1:1,000 epinephrine (1 mg of epinephrine), 1 50-mL vial of lidocaine 2% in a 500 milliliter 0.9% sodium chloride bag, offers improved hemostasis compared to standard lidocaine with epinephrine, with no reported side effects and added benefits of cost savings and protection against lidocaine toxicity.[17] This formulation also remains effective for at least 2 weeks when stored properly.[17]

Proper patient positioning during MMS is also essential to ensure comfort and accessibility of the surgical site, which can reduce procedure time and improve outcomes. Additionally, monitoring for potential adverse reactions, such as vasovagal syncope, is essential, particularly in patients with anxiety or those undergoing procedures on sensitive areas like the face.[5] Clear communication with the patient during the procedure is crucial, as explaining each step can help alleviate anxiety and improve patient cooperation.[5] Healthcare professionals can enhance this procedure's safety, efficiency, and overall success by addressing these perioperative considerations.

Postoperative Considerations

MMS is associated with a low incidence of postoperative complications, ranging from 0.4% to 3%.[18] Common adverse events include bleeding, flap or graft necrosis, wound dehiscence, and infection, with most complications being minor and manageable in an outpatient setting.[18] Bleeding complications, often related to preexisting anticoagulation therapy, are generally well-controlled during surgery.[18] Results from a study confirm the low risk of bleeding during MMS and support continuing medically necessary blood-thinning agents, even for patients on multiple or newer anticoagulants.[19] 

Postoperative infections occur in less than 1% of cases and are associated with increased pain, making pain a valuable marker for infection.[20] Although the overall risk of complications is low, patients who experience 1 complication are at higher risk for additional issues. Patient adherence to wound care instructions is crucial for minimizing postoperative complications, and study results have shown high adherence rates among patients undergoing MMS.[18]

Flap, graft, or skin-edge necrosis is rare, with less than 0.3% of reconstructions affected by necrosis, along with very infrequent hematoma and wound dehiscence.[20] Postoperative pain is typically low, with a reported average pain level of 1.99 on a scale of 0 to 10, and patients generally express high satisfaction with their pain control.[20] Second-intention healing typically results in the least postoperative pain.[20] However, areas such as the nose, lips, and genitalia are associated with higher postoperative pain, indicating the need for more focused pain management in these locations.[20] Additionally, women, younger patients, active smokers, and those requiring multiple stages of surgery tend to report higher levels of postoperative pain, which may necessitate more aggressive pain management strategies.[20]

Despite the rare complications, most are managed by Mohs surgeons, further supporting the procedure's reputation as a safe, effective, and well-tolerated treatment for skin cancer.[20] Long-term follow-up is recommended, especially for patients with high-risk tumors or complex reconstructions, to monitor for late complications or recurrences.[20] Additionally, MMS often results in favorable cosmetic outcomes, particularly in sensitive areas like the face, further enhancing patient satisfaction and the overall success of the procedure.

In cases where MMS resection margins are inadequate or uncertain, early referral for multidisciplinary management is essential, especially for high-risk squamous cell carcinoma.[10] This unfortunate situation often involves additional surgical intervention or postoperative radiotherapy.[10] Providing histological material, detailed operative reports, and visual documentation during referrals enhances the receiving team's ability to plan further treatment effectively.[10] The high success rate of MMS is well-documented; however, complete excision is not always feasible, particularly when tumors invade major anatomical structures or bone, where frozen sections may not provide a complete assessment. These cases highlight the limitations of MMS and the need for a collaborative approach to ensure comprehensive patient care. Integrating multidisciplinary teams, including oncologists, radiologists, pathologists, and surgical specialists, is pivotal in managing these challenging cases and ensuring optimal patient outcomes.

Wound Care

Postoperative wound care following MMS varies widely among surgeons. Research results indicate that topical antibiotics on wounds closed by primary intention do not reduce infection rates and may increase the risk of contact dermatitis.[6] The adhesives used in wound care, such as surgical glues and bandages, can cause allergic contact dermatitis, which is a delayed-type hypersensitivity reaction.[21] Common allergens include benzocaine, lanolin, and components in surgical preparations like povidone-iodine and chlorhexidine.[21] Awareness of these potential allergens is vital in selecting appropriate wound care products to minimize the risk of adverse reactions.[21]

In contrast, using petrolatum or topical silicone on clean dermatologic wounds has shown comparable infection rates without the risk of contact allergies associated with antibiotics.[6] Consequently, topical antibiotics should be carefully considered, given the potential for allergic reactions.[6] Some patients, particularly those who are chronic carriers of Staphylococcus aureus or have a history of methicillin-resistant Staphylococcus aureus infection, may benefit from nasal mupirocin treatment.[6] However, while mupirocin can reduce staphylococcal nasal carriage, it has not been shown to prevent surgical site infections when administered preoperatively.[6]

Another essential consideration in wound care is the readability of patient education materials. Study results have shown that online materials related to MMS wound care often exceed the recommended sixth-grade reading level, making them difficult for many patients to understand.[22] Since MMS is frequently performed on cosmetically sensitive areas, ensuring that wound care instructions are accessible and comprehensible is crucial for optimal healing outcomes.[22]

Adverse Events

MMS is widely recognized for its safety, with an impressively low rate of adverse events and an undetectable mortality rate. In a multicenter prospective study involving 20,821 procedures, adverse events occurred in just 0.72% of cases, with serious events exceedingly rare.[23] The most common complications included infections (61.1%), dehiscence and partial or complete necrosis (20.1%), and bleeding or hematoma (15.4%).[23] Many of these complications, particularly bleeding and wound-healing issues, were associated with patients receiving anticoagulation therapy, though these were generally managed safely during the procedure.[23]

Complications were more frequently observed in specific anatomical locations, with infectious complications more likely on the legs and scalp, bleeding on the neck, and wound-healing issues most frequent on the nose, scalp, and ears.[23] Patients experiencing complications were typically older, with a mean age exceeding 70, and a higher proportion were men.[23] The study results also showed that preoperative use of chlorhexidine and perioperative antibiotics was associated with a lower risk of infection. However, the routine use of antibiotics remains controversial due to concerns about antibiotic resistance.[23] Excessive use of cautery, which can devitalize tissue, was linked to impaired wound healing and infection, though it remains necessary for managing bleeding, particularly in high-risk patients.[23] Overall, MMS remains a highly safe and effective procedure. Most adverse events are minor and manageable, and the surgery's benefits outweigh the risks for most patients.

Issues of Concern

MMS is highly effective, but several considerations must be addressed to ensure optimal patient outcomes and care quality. Patient anxiety, particularly regarding cosmetic outcomes, is a significant concern, especially when the procedure is performed on cosmetically sensitive areas like the face. Addressing this anxiety through preoperative counseling, clear explanations, and support during recovery is crucial for holistic patient care. Ensuring patients are informed about potential cosmetic outcomes and scar management can alleviate concerns and improve satisfaction.[18][24]

Access to MMS can be limited by geographic and financial barriers, presenting disparities that may prevent some patients from receiving this specialized treatment. Addressing these disparities through patient advocacy, telemedicine, and partnerships with local healthcare professionals can help improve access for underserved populations.[10] Additionally, while MMS is cost-effective due to its high cure rates and tissue-sparing technique, the upfront costs and insurance coverage can vary. Healthcare professionals must discuss these aspects with patients to help them understand their insurance benefits and potential out-of-pocket expenses.[23]

Technological advancements, such as improved diagnostic staining and imaging techniques, offer promising improvements in MMS but require careful integration into practice. Ongoing education and training for dermatologists, nurses, and allied health professionals are essential for maintaining high standards of care. Staying updated on the latest techniques, safety protocols, and guidelines through continuing medical education activities is crucial for the entire healthcare team.[10]

Ethical considerations, such as ensuring informed consent and managing patient expectations, are fundamental to the practice of MMS. Avoiding overtreatment and ensuring that MMS is the most appropriate intervention for the patient’s condition is essential. Additionally, while MMS's immediate safety and effectiveness are well-established, ongoing research into long-term outcomes, particularly for high-risk cases, is necessary to refine treatment protocols and improve patient care.[5][10]

Lastly, with growing awareness of environmental issues in healthcare, the environmental impact of surgical waste and the carbon footprint of medical practices are becoming increasingly important.[25] Strategies to reduce waste, such as using nonsterile gloves where appropriate and minimizing disposable instruments, can be integrated into practice to support sustainability.[25] By addressing these concerns, the healthcare team can enhance the overall quality and safety of MMS, ensuring that it remains a patient-centered and effective treatment option for skin cancer.

Clinical Significance

MMS is an effective and safe treatment for skin cancers, particularly those with a high risk of recurrence or located in cosmetically and functionally sensitive areas. By meticulously removing cancerous tissue while preserving as much healthy tissue as possible, MMS achieves superior cure rates and minimizes the need for more extensive surgeries. Comprehensive perioperative care is emphasized, as these are crucial for optimizing patient outcomes and reducing the risk of complications.

Recent developments in MMS have expanded its use in the treatment of melanoma, a significant evolution in dermatologic oncology.[3] Advances in rapid protocols for melanocyte-specific immunohistochemical staining on frozen section specimens have enabled more accurate identification and removal of melanoma cells during surgery.[3] Increasing evidence supports MMS as noninferior or superior to wide local excision, particularly for melanoma in situ and lentigo maligna on special sites like the face.[3] The American Academy of Dermatology has recognized the appropriateness of MMS for treating these conditions in its most recent guidelines, which makes the factors surrounding the MMS procedure of utmost importance in these patients.[3] 

Integrating multidisciplinary management, particularly for complex cases, ensures that patients receive well-rounded care that addresses all aspects of their condition. The involvement of nursing, allied health professionals, and interprofessional teams is crucial for enhancing patient-centered care, ensuring safety, and improving team performance. Their roles in monitoring, wound care, and patient education are vital in achieving successful outcomes and minimizing adverse events.

Ethical considerations, patient education, and the psychosocial impact of MMS are also critical components of a holistic approach to patient care. This course highlights the significance of these factors in providing a comprehensive treatment experience. Additionally, the discussion on new developments and technological advancements provides insight into the future direction of MMS. At the same time, the focus on environmental sustainability reflects a growing awareness of healthcare's broader impact. In summary, MMS continues to set the standard for excellence in dermatologic surgery. Through careful consideration of all aspects of care, from initial evaluation to long-term outcomes and the integration of new advancements, MMS remains a patient-centered, multidisciplinary approach to treating skin cancer that is both effective and forward-looking.

Enhancing Healthcare Team Outcomes

MMS requires a multidisciplinary approach to ensure safe and effective perioperative care. To optimize outcomes, advanced clinicians must possess advanced skills in assessing tumor margins, selecting appropriate repair techniques, and addressing patient-specific comorbidities. Nurses are vital in perioperative preparation, including patient education, sterile field maintenance, and postoperative wound care. Pharmacists contribute by ensuring the proper selection and administration of local anesthetics, antibiotics, and analgesics, particularly for patients with complex medication histories or allergies. Clear communication between all team members is essential to coordinate care, prevent complications, and address patient concerns throughout the surgical process.

Multidisciplinary management is a crucial aspect of care for patients undergoing MMS, particularly in complex or high-risk cases. Interprofessional communication and coordination among advanced clinicians, nurses, pharmacists, and other healthcare professionals enhance patient-centered care, outcomes, and safety. Over 15 years, results from a retrospective analysis at a quaternary cancer center showed that only 0.2% of MMS cases required referral for further treatment, underscoring the high efficacy of MMS and the critical importance of collaborative care in select complex cases.[10] This integrated approach ensures patient comfort, reduces complications, and promotes efficient teamwork—ultimately improving surgical outcomes and satisfaction.

Nursing, Allied Health, and Interprofessional Team Interventions

In the context of MMS, nursing and allied healthcare professionals play a vital role in ensuring optimal patient care and outcomes. Nurses provide education, manage wound care, and monitor for complications like bleeding or infection, which is crucial given the variable adherence to postoperative care.[18] Allied health professionals, such as medical assistants and surgical technologists, support the procedure by preparing the surgical site, assisting with instruments, and maintaining infection control, significantly reducing infection rates.[14] Pharmacists help manage medications, including anticoagulants and antibiotics, to optimize surgical outcomes.[1] Effective interprofessional collaboration ensures comprehensive care, enhancing patient safety and improving outcomes following MMS.[10]

Nursing, Allied Health, and Interprofessional Team Monitoring

Monitoring during and after MMS is vital to patient care, requiring coordinated efforts from the entire interprofessional team. Nurses and medical assistants are key in assessing patient status and anxiety, monitoring vital signs, pain levels, and wound healing, and promptly addressing complications like bleeding, infection, or dehiscence.[18] Allied health professionals assist in intraoperative monitoring, helping manage issues such as excessive bleeding or equipment malfunctions. Postoperatively, nurses and medical assistants ensure adherence to care instructions and monitor wound healing, while pharmacists and/or primary care clinicians oversee medication management, adjusting anticoagulation and antibiotic regimens as needed.[14] This collaborative monitoring ensures a smooth surgical experience and successful recovery for patients undergoing MMS.[10]