Minor postoperative bleeding is the most common complication of cutaneous surgery. Because of the commonality of this complication, hemostasis is an important concept to address when considering dermatologic procedures. Patients that have a bleeding diathesis, an inherited/acquired coagulopathy, or who are on anticoagulant/antiplatelet medications pose a greater risk for bleeding complications during the postoperative period. Knowledge of these conditions preoperatively is of the utmost importance, allowing for proper preparation and prevention. Also, it is important to be aware of the various hemostatic modalities available, including electrocoagulation, which is among the most effective and widely used techniques. Prompt recognition of hematoma formation and knowledge of postoperative wound care can prevent further complications such as wound dehiscence, infection, or skin-graft necrosis, minimizing poor outcomes. 1. Introduction Dermatologists are estimated to perform over 3.9 million procedures each year [1]. Although the risks and complications of dermatologic surgery are generally very low, even the most talented surgeon can experience complications related to hemostasis during both the intraoperative and postoperative periods. Minor bleeding complications are the most frequently encountered complications of cutaneous surgery, which can predispose the patient to hematoma formation, increased risk of infection, skin graft necrosis, and wound dehiscence. This chapter will highlight proper hemostasis technique to prevent complications. 2. Overview of Hemostasis By understanding the mechanism behind the physiologic clotting system, it is easier to understand how the different hemostatic agents work in the body. The body’s primary response to injury is reflex vasoconstriction of the blood vessels in the surrounding tissues, followed by formation of the platelet plug and activation of the fibrinolytic clotting cascade. There are two separate pathways of the fibrinolytic clotting system, that lead to the final common pathway and formation of the insoluble fibrin clot. Function of the body’s hemostatic system can be monitored by various laboratory tests. These tests can be helpful to assess the degree of anticoagulation in patients on antiplatelet and anticoagulant medications or who have inherited coagulopathies before proceeding with dermatologic procedures (see Table 1). Table 1: Overview of hemostasis. 3. Preoperative Evaluation One of the most important steps that the dermatologist can take to prevent bleeding complications is to gain a thorough
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