Comparison of Outcomes of Early vs Delayed Graft Reconstruction of Mohs Micrographic Surgery Defects

Abstract

IMPORTANCEReconstructing Mohs defects often requires grafting in the form of full-thickness skin grafts (FTSGs) and composite grafts. These grafts can be complicated by a variable and often indeterminable survival rate. Other researchers have found that delaying FTSG reconstruction improves graft outcomes, but the optimal interval between excision and reconstruction remains unclear, and no study has examined the association between delaying composite graft reconstruction and graft survival.OBJECTIVE To review the outcomes of Mohs micrographic surgery defect reconstruction using FTSG and composite grafts with respect to patient-and surgery-specific variables, particularly early vs delayed reconstruction. DESIGN, SETTING, AND PARTICIPANTSThis retrospective, single-institution cohort study assessed patients who underwent Mohs reconstructive surgery from January 1, 2012, to January 1, 2018. No patients had to be excluded for inadequate follow-up or incomplete medical records. Delayed reconstruction was defined as greater than 6 days after Mohs excision, the third quartile of the interval to reconstruction among our cohort.MAIN OUTCOMES AND MEASURES Primary outcome was postoperative complications, including hematoma, infection, dehiscence, epidermolysis, and partial or full graft loss.RESULTS A total of 320 defects were reconstructed with FTSG or composite grafts in 310 patients (median [range] age, 68 [21-96] years; 167 female [53.9%]) during the 6-year study period. The mean interval between the ablative and reconstructive operations was 4.73 days (range, 0-35 days). Univariate logistic regression was used to determine the significant indicators among patient and defect characteristics analyzed. A multivariate logistic regression model found delayed reconstruction to have a protective association (odds ratio, 0.52; 95% CI, 0.27-0.97; P = .046) and male sex to have a harmful association (odds ratio, 2.51; 95% CI, 1.52-4.20; P < .001) with postoperative complications.CONCLUSIONS AND RELEVANCE This study found that delaying reconstruction in FTSGs and composite grafts was associated with decreased rates of postoperative complications, and male sex was associated with an increased risk of postoperative complications. The findings suggest that this strategy can be considered in patients at increased risk for developing postoperative complications, such as current smokers, patients with large defects, and patients who require use of composite grafts.LEVEL OF EVIDENCE 3.

Patient, Defect, and Surgical Factors Influencing Use of Ancillary Procedures after Facial Mohs Repairs

“…Contrary to a prior study, 7 our results indicate that the incidence of any type of complication was not dependent on time delay or method of closure. Our study shows a trend toward a higher risk of scar revision when the defect repair was delayed, but it is not possible to exclude confounding variables due to the small number of delayed closures.…”

Do Postoperative Antibiotics Affect Outcomes in Mohs Reconstructive Surgery?

“…In this work, we demonstrated that these are also risk factors specifically for postoperative infections. Prior work has also demonstrated composite grafts increase the risk for overall complications after MMS 15,16,25,26 . We did not find a statistically significant association, however, between use of composite grafts and SSIs.…”

“…Our group and others have demonstrated that smoking and use of cartilage grafts are associated with an increased risk of overall complications after Mohs surgery 15,16,21–24 . In this work, we demonstrated that these are also risk factors specifically for postoperative infections.…”

“…Furthermore, we wanted to evaluate other potential predictors of SSI so Our group and others have demonstrated that smoking and use of cartilage grafts are associated with an increased risk of overall complications after Mohs surgery. 15,16,[21][22][23][24] In this work, we demonstrated that these are also risk factors specifically for postoperative infections. Prior work has also demonstrated composite grafts increase the risk for overall complications after MMS.…”

“…11 Multiple studies have demonstrated the very low incidence of postoperative surgical site infection (SSI) after MMS, even in the absence of prophylactic antibiotics. [12][13][14][15][16] We endeavored to study a large cohort of patients reconstructed after MMS of the head and neck to determine the rate of SSI in relation to factors such as prophylactic antibiotic use, defect size, and patient comorbidities such as smoking. We hypothesized that use of postoperative antibiotics is not associated with a decreased risk of infection, even in patients with large and/or full-thickness defects.…”