Hemostasis using patient applied manual pressure after the first layer of Mohs surgery

Electrosurgery is a commonly used method for hemostasis, it carries risks, including device interactions, smoke inhalation, and tissue necrosis. Manual pressure is a low-risk alternative, but data on its effectiveness and duration for achieving hemostasis in Mohs micrographic surgery (MMS) wounds is limited. This study aims to quantify the time required for surgical wounds to achieve hemostasis using patient-applied manual pressure during MMS and assess factors influencing hemostasis, such as anticoagulant use and anatomical site. A retrospective chart review included 178 wounds from 159 patients who underwent MMS from August 2022 to August 2023. Data collected included age, sex, wound size, tumor type, bleeding type, anatomical site, anticoagulant use, and hemostasis time. Patients applied manual pressure under supervision for up to 20 min. Manual pressure achieved hemostasis in 47.9% of anticoagulated wounds and 60.7% of non-anticoagulated wounds within 20 min (p = 0.03). Wounds on the nose, scalp, and neck achieved hemostasis significantly faster. Anticoagulants prolonged hemostasis time, with a hazard ratio of 0.64. Manual pressure is effective for hemostasis in MMS, particularly for non-anticoagulated patients. Anatomical site and anticoagulant use significantly influence hemostasis duration. Surgeons should consider these factors when planning hemostatic interventions.