Successes, Revisions, and Postoperative Complications in 446 Mohs Defect Repairs
21 June 2012 (online)
Objective To determine factors predictive of complications and the need for adjunctive treatments repair of facial Mohs defects.
Methods Charts of patients undergoing repair of facial defects from 2000 to 2010 in an academic facial plastic surgery practice were reviewed for patient medical history, tumor type, defect site and size, method of repair, postoperative sequelae, and adjunctive treatments.
Results A total of 446 Mohs defect repairs were analyzed. Average patient age was 61.54 ± 14.81 years. The average defect size was 17.55 ± 10.48 mm. Overall complications were fairly uncommon and required intervention in only 18.74%; other than postoperative corticosteroid injections, additional procedures were necessary in only 6.95% of patients. Female sex; Fitzpatrick skin type 3; upper lip and nasal defects; glabellar, superiorly based nasolabial, bilobed, and rhombic flaps; and dermal suture extrusion were associated with increased complications. The most common complications seen were scar erythema and flap pincushioning. The most common revision techniques performed/recommended were selective laser photothermolysis (3.59%) and scar excision (3.59%).
Conclusion Repair of Mohs defects uncommonly requires adjunctive/revision techniques to reach satisfactory appearance. By understanding certain factors related to the patient, the defect, and the method of repair, surgeons can better choose reparative techniques and anticipate patient postoperative needs.
- 1 Burget GC, Menick FJ. The subunit principle in nasal reconstruction. Plast Reconstr Surg 1985; 76: 239-247
- 2 Burget GC, Menick FJ. Nasal reconstruction: seeking a fourth dimension. Plast Reconstr Surg 1986; 78: 145-157
- 3 Burget GC, Menick FJ. Nasal support and lining: the marriage of beauty and blood supply. Plast Reconstr Surg 1989; 84: 189-202
- 4 Burget GC. Aesthetic Reconstruction of the Nose. 2nd ed. St. Louis: Mosby, Inc.; 1993
- 5 Baker SR. Local Flaps in Facial Reconstruction, 2nd ed. St. Louis: Mosby, Inc.; 2007
- 6 Sherris D, Larrabee WF eds. Principles of Facial Reconstruction: A Subunit Approach to Cutaneous Repair, 2nd ed. New York: Thieme; 2009
- 7 Dzubow LM. The dynamics of flap movement: effect of pivotal restraint on flap rotation and transposition. J Dermatol Surg Oncol 1987; 13: 1348-1353
- 8 Dzubow LM. Repair of defects on nasal sebaceous skin. Dermatol Surg 2005; 31 (8 Pt 2) 1053-1054
- 9 Collins SC, Dufresne Jr RG, Jellinek NJ. The bilobed transposition flap for single-staged repair of large surgical defects involving the nasal ala. Dermatol Surg 2008; 34: 1379-1385 ; discussion 1385–1386