Water Exposure at 6 Hours After Cutaneous Surgery Does Not Increase the Risk of Complications

Is water exposure at 6 hours after cutaneous surgical treatment of benign or malignant lesions, including standard excisional surgery and Mohs surgery with immediate reconstruction, safe?

The study found that early water exposure as soon as 6 hours after cutaneous surgery for dermatologic lesions did not increase the risk of infection or bleeding compared with standard instructions to keep the wound dressing dry for 48 hours. Scar quality at 6 months was similar in both groups. (Level of Evidence = 1b−)

Patients are traditionally advised to keep initial postoperative dressings dry for 24 to 72 hours after cutaneous surgery. The investigators identified adults 18 years or older who were undergoing surgical treatment of benign or malignant lesions, including standard excisional surgery or Mohs surgery with immediate reconstruction. Eligible participants (N = 437) randomly received postoperative instructions for early water exposure (ie, remove the dressing after 6 hours and wet the wound for at least 10 minutes in a shower, bath, or pool) or standard advice to keep the dressing dry for 48 hours. The individuals who assessed all outcomes remained masked to group assignment. Complete follow-up occurred for 100% of patients at 14 days. A smaller subset of participants (n = 146) was asked to return at 6 months.

Using intention-to-treat analysis, the rate of postoperative infection, defined as a positive wound culture, was similar in the standard and early water exposure groups (1.4% vs 1.8%, respectively). Similarly, no significant group differences occurred in the rate of bruising or hematoma. At the 6-month follow-up, scar quality was measured by a standard scoring tool and was similar in both groups.

Study design: Randomized controlled trial (single-blinded)

Funding source: Foundation

Allocation: Concealed

Setting: Outpatient (specialty)

Reference: Samaan C, Kim Y, Zhou S, et al. Early postoperative water exposure does not increase complications in cutaneous surgeries: a randomized, investigator-blinded, controlled trial. J Am Acad Dermatol. 2024;91(5):896-903.