Few Downsides to Delaying Mohs Reconstructive Surgery

By Marilynn Larkin

September 14, 2017

NEW YORK (Reuters Health) – Timing of Mohs reconstructive surgery is not associated with increased risk of infection or flap failure, though some postoperative complications may occur, depending on patient- and surgery-specific variables, researchers say.

“Mohs micrographic surgery . . . is the standard of care for some skin cancers on the face, and these surgeries leave defects which typically require surgical reconstruction,” Dr. Matthew Miller of the University of Virginia Health System in Charlottesville explained in an email to Reuters Health.

“There is no margin for error when reconstructing these facial defects,” he noted. “Even small imperfections on the face are obvious in our day-to-day interactions.”

Because a recent study found that waiting more than two days to reconstruct defects after Mohs surgery was associated with an increased risk of postoperative complications, Dr. Miller and colleagues reviewed all Mohs reconstructions for cutaneous squamous cell carcinoma or basal cell carcinoma performed by one of the study authors from January 2012 through March 2017, even though the team had not observed problems.

As reported online September 7 in JAMA Facial Plastic Surgery, reconstructions were done for 633 defects in 591 patients (median age, 65; 56% women) during the five-year period.

Reconstructions were performed from less than 24 hours to 32 days after Mohs surgery; more than a third (36.2%) were delayed longer than 48 hours.

The analysis of postoperative complications looked at patient-specific variables such as comorbidities, age, smoking status, and use of anticoagulant or antiplatelet medications, as well as surgery-specific variables, including location and size of defect, time interval between Mohs surgery and reconstruction, and reconstructive modalities.

The postoperative complication rate was 9.3% overall. Factors significantly associated with an increased risk of complications included smoking (odds ratio, 2.46), defect size (OR, 1.04), full-thickness defects (OR, 1.56), interpolated flaps with cartilage grafting (OR, 8.09) and composite grafts (OR, 6.35).

“We found no association between the timing of facial reconstruction and whether the patient develops a postoperative complication that would be associated with a delay in repair,” Dr. Miller stressed.

“This finding supports the notion that delaying reconstruction will not affect postoperative outcomes,” he concluded. “We hope this finding will help facial reconstructive surgeons counsel their patients in terms of options and timing.”

Dr. Stephen Warren, Associate Professor of Plastic Surgery at NYU Langone Medical Center and Associate Professor of Oral and Maxillofacial Pathology, Radiology and Medicine at NYU College of Dentistry in New York City, told Reuters Health, “It has been conventional wisdom for years that Mohs facial defects can be delayed for reconstruction without consequences.”

“This study confirms that finding,” he said by email, “but moreover, also confirms that other well-known factors – e.g., smoking status, size of the defect, full-thickness defects, interpolated flaps with cartilage grafting and the use of composite grafts - do, in fact, increase complications.”

“I’ve always told patients that they could present to my office two hours or two weeks after Mohs surgery and that we would obtain the same results,” Dr. Warren noted. “This study substantiates that point of view.”

SOURCE: http://bit.ly/2f4opGf

JAMA Facial Plast Surg 2017.

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