Moy, Fincher, Chipps Medical Group

Abstract Background Post-operative complications such as bleeding, hematoma formation and abnormal healing may be mitigated by withholding selected over-the-counter products including dietary supplements. Little is known about patients’ knowledge on this subject. Objective To assess participants’ baseline knowledge about common over-the-counter supplements, vitamins, herbal/botanical products as well as other substances (e.g., alcohol) that can be associated, if ingested, with an increased risk of bleeding during outpatient surgical procedures. Methods A survey administered to a willing consecutive sample of adults regarding their: baseline knowledge about possible bleeding risks associated with commonly taken dietary supplements and products; personal use of supplements and alcohol; history of post-procedural bleeding or healing issues; and personal demographic characteristics. Results One hundred and two participants completed the survey (93% response rate). Overall knowledge of risks was low (average score = 8/56 = 14%). Gender, supplement usage or non-usage, and use of prescription anticoagulants did not significantly impact score. Increasing age was negatively correlated with score. 69% of participants reported routinely taking supplements of any kind. 88% thought receiving information on this topic before surgical procedures about supplements that could affect procedure-related bleeding would be helpful. Conclusion Most participants were unaware of the potential bleeding risks of common dietary supplements but wanted education on the topic. Pre-operative education that encourages patients to hold selected supplements and other ingested substances may reduce peri-operative bleeding risk associated with cutaneous surgery.

A 46-year-old man of Japanese descent presented with a pigmented patch under his right eye that had been present since birth. He had no history of ocular disease, hearing loss, or use of medications that produce pigmentation. Throughout his early life, the lesion had been significantly larger, and 25 years before he presented to our clinic, it had been partially excised, resulting in a smaller patch with some white central scarring that was visible in the center (Figure 1). Physical examination revealed a blue-gray, hyperpigmented, poorly defined patch on the right infraorbital cheek area. There was no pigmentary disturbance of either eye or the oral mucosa. Other than long-standing, bilateral tear-trough deformity–related hyperpigmentation, the patient had no other pigmented macules or patches on his head or neck.