Nasal Reconstruction after Mohs Cancer Resection: Lessons Learned from 2553 Consecutive Cases

Halani, Sameer H.; Ma, Connie; Pierce, J.; Sanniec, Kyle; Thornton, James F.

doi:10.1097/prs.0000000000008098

Cited by 21 publications

(22 citation statements)

References 29 publications

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“…The majority of patients undergoing reconstructive surgery following Mohs micrographic surgery typically have their procedure performed under sedation with long-lasting local anesthetic, as such the concern for life-threatening complications occurring during surgery is low. 8 9 10 The reconstructive surgeon should also elucidate whether or not the patient is on antiplatelet and anticoagulant medications. Generally, these medications do not need to be discontinued when reconstructing a single, small defect; however, the senior author often requires that patients discontinue both medications when reconstructing a single, large defect or multiple defects in one surgery to minimize intraoperative complications related to excessive bleeding.…”

Section: Preoperative Evaluationmentioning

confidence: 99%

Use of Biologic Agents for Lip and Cheek Reconstruction

Depani

Thornton

2021

Semin Plast Surg

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The unique requirements of reconstructing cheek defects, often with its proximity to the mobile elements of the face including the lip and the eyelid, have been met very handily with the directed and thoughtful use of biologic wound healing agents. One of the key advantages of these agents is their ability to provide coverage in patients with multiple comorbid conditions for the mobile elements of the cheek where the cervicofacial advancement flap is contraindicated due to its anesthetic requirement. The biologic agents are also highly successful coverage options for patients who have limited skin laxity to provide for proper skin closure using the standard cheek closure techniques with local flaps. In addition, these agents provide an ability to provide stable wound closure with minimal wound care while waiting for the excisional biopsy results to be finalized. This article describes the unique indications for biologic wound agents, including preservation of lip and eyelid mobile element anatomy without retraction from a local flap, which has not been previously described.

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Section: Preoperative Evaluationmentioning

confidence: 99%

Use of Biologic Agents for Lip and Cheek Reconstruction

Depani

Thornton

2021

Semin Plast Surg

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“…are columella-only. 67 The bilobed flap has been shown to yield good results for lateral alar or nasal tip defects, but nasal distortion with this technique is a concern for midline defects. An alternative, the half-bilobed flap, has been shown to be equivalent with regard to pin cushioning, tip narrowing, scarring, and infection, but superior in maintaining nasal symmetry.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

State of the Evidence for Facial Skin Cancer Reconstruction

et al. 2023

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This review provides a comprehensive presentation of the evidence available in facial reconstruction post-Mohs Micrographic Surgery. Given the large diversity in post-Mohs reconstruction, there are limited guidelines in the management of defects. The aim of the present work is to provide a review of the best evidence as it pertains to several considerations in facial reconstruction. Data suggests that Mohs Micrographic Surgery and many reconstructive procedures can be performed as outpatient procedures under local anesthesia, with narcotic pain medication only given in certain patient populations following a minority of reconstructive procedures. Perioperative and topical antibiotics are generally not indicated. Aspirin and Warfarin can generally be continued for most reconstructive procedures, but clopidogrel and novel anticoagulants may predispose to increased bleeding complications. Delayed reconstruction appears to be safe, although data is discordant on this topic. No specific wound closure technique or suture choice appears to be consistently superior. Given the lack of robust comparative studies, consistent methodology, and variable defect sizes/ locations, no robust evidence-based guidelines can be generated for reconstruction techniques of facial subsites.

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“…The clinical indications for the application of these products are patients with comorbid conditions precluding them from surgery, limitations of donor tissue, previous flap reconstruction, and patient preference. 12 21…”

Section: Brief Overview Of Surgical Techniques and Postoperative Mana...mentioning

confidence: 99%

Use of Biologic Agents in Nasal and Scalp Reconstruction

et al. 2022

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Oncologic reconstruction of the nose and scalp following Mohs micrographic surgery poses a significant challenge for plastic surgeons. While these defects are traditionally reconstructed using primary closure techniques, skin grafts, local flaps, pedicled flaps, and free tissue transfer, the incorporation of biologic healing wound agents such as Integra and Cytal provides patients and surgeons with alterative reconstructive options without additional donor site morbidity. Herein, we review the use of biologic agents used in soft tissue reconstruction of the nose and scalp following Mohs surgery.

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Nasal Reconstruction after Mohs Cancer Resection: Lessons Learned from 2553 Consecutive Cases

Cited by 21 publications

References 29 publications

Use of Biologic Agents for Lip and Cheek Reconstruction

Use of Biologic Agents for Lip and Cheek Reconstruction

State of the Evidence for Facial Skin Cancer Reconstruction

Use of Biologic Agents in Nasal and Scalp Reconstruction

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