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Delays, techniques, tumor location impact Mohs surgery reconstruction

Factors such as 2-day delay of surgery, interpolated flap use with cartilage grafting and composite location influenced complications of reconstruction after Mohs micrographic surgery, according to recent research published in JAMA Facial Plastic Surgery.

Sapna A. Patel, MD , from the department of otolaryngology–head and neck surgery, at the University of Washington, and colleagues performed a retrospective analysis of 342 patients at the University of Washington Medical Center and Virginia Mason Medical Center who underwent 415 Mohs micrographic surgeries (MMS) from February 1989 through December 2012. Patients underwent MMS to address facial carcinomas, and the reconstruction surgery was performed on the same day or was delayed between 1 day and 11 days after excision.

The researchers found 95.4% of patients had reconstruction within 2 days of MMS. There was an overall complication rate of 8.2%, a 7.7% complication rate among patients who underwent delayed reconstruction and a 2.4% infection rate, the researchers wrote. Patel and colleagues noted patient characteristics, exposure of cartilage and bone, large defects and reconstruction delayed by 2 days or more were associated with complications. Composite defects and interpolated flap use with cartilage grafting were associated with complications.

In a multivariate analysis, Patel and colleagues found 2-day delay of surgery (P = .02; 95% CI, 1.24-14.6), interpolated flap use with cartilage grafting (P = .01; 95% CI, 1.44-16.95) and composite defect location (P = .03; 95% CI, 1.16-10.56) were associated with complications (likelihood ratio = 31.76; P < .001).

“Our total rate of complications, 8.2%, is similar to rates reported by others, but it is difficult to generalize and compare the results of other studies because most of the studies are retrospective, surgeons do not define wound complications similarly, and defect characteristics may differ between the reporting specialties (ie, dermatology vs separate reconstructive surgery),” Patel and colleagues wrote.

“Although not always the case,” they said, “it can be postulated that many of the MMS defects referred to be repaired by a reconstructive surgeon may be larger and more complex than those repaired by the Mohs dermatologic surgeon.” – by Jeff Craven

Disclosure: The researchers report no relevant financial disclosures.