Reconstruction after Mohs Surgery: A Matter of Timing
- Posted on: Jan 15 2018
Physicians who obtain the necessary training and certification to perform Mohs Micrographic Surgery do so because they have a strong desire to improve patient outcomes. Mohs presents an opportunity to increase efficacy while simultaneously decreasing tissue disruption. As refined as this technique is compared to the standard surgical excision of skin cancers, there are instances in which a patient will need to undergo reconstructive surgery following Mohs. In such cases, the matter of timing needs to be understood.
Historically, it has been believed that reconstruction needs to occur in a relatively prompt manner after skin cancer surgery. The theory has been that, if we wait too long – longer than a couple of days – the risk of postoperative complications increases. A recent article reflecting a careful case study was published in the Journal of the American Medical Association. This report indicates that other factors have greater significance in the outcome of surgical reconstruction. Here, we take a brief look at the case review conducted by Dr. Matthew Miller of the University of Virginia Health System in Charlottesville and a few of his colleagues.
To observe clinical outcomes, a review of all reconstructions after Mohs treatment for basal cell carcinomas and cutaneous squamous cell carcinomas was performed. Cases spanned from the beginning of 2012 to the Spring of 2017. Of these cases, 591 patients underwent reconstruction. The timing of reconstruction may have been within one day after the Mohs procedure, up to 32 days. Greater than 35% of these reconstructions occurred more than 48 hours after skin cancer surgery.
Taking into account important variables such as the location and size of the defect, modalities involved in reconstruction, the use of certain medications, and patients’ smoking status and age, the study authors found that the overall postoperative complication rate was just over 9%. Furthermore, the timing of surgery was of minimal consequence compared to other factors such as the use of composite grafts, the thickness of the post-surgical defect, and smoking status.
Timing is a matter of importance any time we are dealing with invasive skin cancers. Mohs surgeons, whether directly involved in surgical reconstruction or not, can benefit from this information, supporting the suggestion that post-surgical outcomes do not suffer when reconstruction is postponed for a short period of time.
For the original piece, visit JAMA Facial Plastic Surgery online, Sept. 7, 2017.
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Posted in: MOHS Surgery