Evidence-Based Clinical Practice Guideline: Reconstruction after Skin Cancer Resection

Abstract

Summary: A multi-disciplinary work group involving stakeholders from various backgrounds and societies was convened to develop guidelines for the management of reconstruction after skin cancer resection. The goal was to identify areas of common ground and provide evidence-based recommendations to improve patient care. Given the heterogeneity of reconstructive techniques and clinical scenarios, investigation centered around common elements in the process. In some cases, a distinction was made between treatment options in the office-based setting as opposed to those in the facility setting. A systematic literature review was performed, and an established appraisal process was used to rate the quality of relevant scientific research (Grading of Recommendations Assessment, Development, and Evaluation methodology). Final recommendations are related to concepts concerning the timing of reconstruction, management of anticoagulation, use of antibiotics, methods of pain control, and follow-up assessment. At times, there was insufficient evidence to make high-level recommendations. The literature analysis highlights the need for additional methodologically robust studies in this area, to help guide clinical practice.

Evidence-Based Performance Measures for Reconstruction after Skin Cancer Resection: A Multidisciplinary Performance Measure Set

“…The measure narratives are listed in Tables 1 through 7. 1–70 To implement the measures and view all the specifications, please see Appendix, Supplemental Digital Content 1 , which shows the reconstruction after skin cancer resection measurement specifications, http://links.lww.com/PRS/G455.…”

“…These measures were originally constructed to follow the scope of the multidisciplinary guideline, Evidence-Based Clinical Practice Guideline: Reconstruction after Skin Cancer Resection. [9][10][11] Convened by the ASPS, the guideline work group focused on overarching principles relevant to many different reconstructive strategies, and produced in a guideline copublished in three key journals. [9][10][11] The guideline assumes that the skin cancer is resected, and the margins are clear of tumor.…”

“…[9][10][11] Convened by the ASPS, the guideline work group focused on overarching principles relevant to many different reconstructive strategies, and produced in a guideline copublished in three key journals. [9][10][11] The guideline assumes that the skin cancer is resected, and the margins are clear of tumor. Reconstruction is defined by the guideline as cutaneous closure that requires a flap, graft, or tissue rearrangement.…”

“…Surgical sites at intrinsically high risk of infection: lower extremities and intertriginous areas (groin, genitalia, perianal, axilla). [9][10][11] Measure importance Exception justification Exceptions to this recommendation and measure are appropriate for reconstructions in special high-risk populations, such as those requiring large or complex reconstructions, those with clean-contaminated or chronic wounds, or those with medical histories or comorbidities associated with immunosuppression or elevated risk of infection. Below-knee surgery has been shown to have a higher infection rate.…”

“…It is recommended that a field be created in the surgeon's EMR to document this, outside of the free text, as this information may be stored in a scanned PDF from the pathologist and would not be readily available for electronic capture. [9][10][11] Measure importance Rationale/opportunity for improvement Reconstruction after skin cancer resection may have myriad functional and cosmetic outcomes. The return of the patient for followup clinic visits is an excellent opportunity to better understand and measure these outcomes, improve patient-physician communication, and foster quality improvement.…”