Surgical smoke: Risk assessment and mitigation strategies

Background: Although many dermatologic surgeons are aware of the risks of surgical smoke, many do not use hazard reduction strategies. Objective: To identify the infectious, inhalational, chemical, and mutagenic risks of surgical smoke in dermatologic procedures and suggest evidence-based hazard reduction strategies. Methods: A review of articles indexed for MEDLINE on PubMed using the keywords surgical smoke, dermatology, surgical mask, respirator, smoke evacuator, and guidelines in 13 combinations was performed by using Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocols. The review included data from 45 articles from the dermatology, surgery, infectious disease, obstetrics, and cancer biology literature. Results: There are risks associated with surgical smoke, and although some dermatologists are aware of these risks, many are not using hazard reduction strategies such as smoke evacuators and surgical masks. Limitations: Most of the data regarding the hazards of surgical smoke and methods for smoke safety are derived from in vitro and in vivo studies in nonhumans, as well as from resources outside of the dermatology literature. Conclusion: Standardized guidelines for surgical smoke safety should be implemented in the dermatology community and residency curriculum.