Introduction
Below-knee dermatologic surgery has a high risk for complications such as wound infection, bleeding, necrosis and dehiscence. In this study, we evaluated the impact of preoperative appointments on complication risks.

Methods
We searched the medical records of HUS Dermatosurgery unit for all below-knee surgeries during year 2016 and 2018. In 2018, the preoperative nurse appointments for risk patients were introduced. We documented patient demographics, surgery type and any complication during that year and compared it to 2016, when no preoperative appointments were done. At the appointments, risk factors were evaluated, treated and compression therapy was introduced. Analyses included 366 patients, 68 appointment attendants.

Results
Complication rates were 10.1% year 2018 versus 13.4% year 2016 (P=0.33), despite significantly higher risks in the 2018 population. Complication risk for appointment attendants versus non-attendants reduced after adjustments by odds 0.58, however statistically insignificantly (P=0.47). For full-thickness skin grafts, the odds 11.33 for complications was considerably higher versus other surgery techniques (P=0.00).

Conclusions
The introduction of preoperative appointments seems to reduce complications in below-knee surgery. For graft reconstructions, the complication risk is high, even with carefully planned preoperative care. Further studies are needed to evaluate preventable risk factors of below-knee graft reconstructions.

Evaluating complications in below-knee skin cancer surgery after introduction of preoperative appointments: a retrospective cohort study