xRead - Facial Reconstruction Following Mohs Micrographic Surgery

Research Original Investigation

Complication Rates in Delayed Mohs Reconstruction Surgery

Table 1. Demographics and Characteristics for 342 Patients Undergoing Delayed MMS Characteristic No. (%) Age, median (range), y 64 (28-95) Sex Male 140 (41) Female 202 (59) Smoking Current 30 (8.7) DM, immunocompromised 43 (12.6) Previous radiation treatment 12 (3.4) Recurrent disease 50 (12) Coumadin 22 (6.3) Antiplatelet, NSAID 90 (26.3) Abbreviations: DM, diabetes mellitus; MMS, Mohs micrographic surgery; NSAID, nonsteroidal anti-inflammatory drug. Table 2. Tumor Type and Location for Mohs Micrographic Surgery and Reconstructive Method Tumor Type and Location No. (%) Location (n = 415) Scalp 17 (4.1) Forehead 43 (10.4) Eyelid 28 (6.7) Nose 185 (44.6) Cheek 44 (10.6) Ear 27 (6.5) Lip 40 (9.6) Chin 3 (0.7) Neck 5 (1.2) Composite 23 (5.5) Tumor type for MMS (n = 415) Basal cell carcinoma 323 (77.8) Squamous cell carcinoma 64 (15.4) Melanoma 13 (3.1) Other 9 (2.2) Unknown 6 (1.4) Type of closure (n = 415) Complex closure 74 (17.8) Free grafts 67 (16.1) FTSG 62 (91.1) STSG 4 (7.1) Both FTSG and STSG 1 (<1.0) Local flap 195 (47.0) Interpolated flap 50 (12.0) With cartilage 31 (7.5) Free flap 1 (<1.0) Composite graft 28 (6.8) Auricular composite graft 11 (2.7) Abbreviations: FTSG, full-thickness skin graft; MMS, Mohs micrographic surgery; STSG, split-thickness skin graft.

Table 3. Types in 415 Complications Type

No. (%) 2 (0.5) 32 (7.7) 3 (0.7) 10 (2.4) 3 (0.7) 6 (1.4) 10 (2.4) 34 (8.2) 0

Immediate complications Delayed complications

Hemorrhage Hematoma

Wound infection

Flap necrosis Dehiscence

Other

Total

exact test was used for any cell count values less than 10; oth erwise,χ 2 test was used. We then conducted multivariate analy sis using logistic regression models, which included variables with P < .05 from bivariable analysis. STATA statistical soft ware was used for this analysis. Results A total of 415 cases in 342 patients met our inclusion criteria for the study. Table1 describes general demographic data for the cohort, and patient characteristics that may have affected surgical outcomes. Nine percent of the cohort were active smokers. Approximately one-third of patients (32.6%) were tak ing coumadin, an antiplatelet agent, or NSAIDs preopera tively. Table2 shows the distribution of cutaneous cancers with basal cell carcinoma representing 77.8% of the lesions. The mean duration of follow-up was 273 days, with a range of 6 to 1163 days. Most defects (95.4%) were repaired within 2 days of MMS, with a range of 1 to 11 days after resection. The most common location of defects referred for de layed repair was on the nose (44.6%). Table 2 outlines the dis tribution of defect locations. Fifty-five percent of the defects were considered large defects, and 16.3% of defects had car tilage or bone exposure. The most common reconstructive mo dality in our cohort was an adjacent tissue transfer local flap (Table 2). Fifty interpolated flaps were performed, with 40 (80.0%) being paramedian forehead flaps. Of the 50 interpo lated flaps, 31 (62.0%) required cartilage graft for framework reconstruction. The total complication rate was 8.2%, with 2 immediate complications (atrial fibrillation and hematoma) and a total of 32 delayed complications ( Table 3 ). The most common de layed complications were infection and “other.” The other complications included vestibular stenosis, saddle nose de formity, and septal perforation, in patients with large or full thickness nasal defects requiring reconstruction of both the nasal framework and soft tissue. In addition, epiphora, tele canthus, and eyelid retraction were included as other compli cations for patients who underwent eyelid reconstruction. The overall infection rate was 2.4%. Stratifying by defect size, only 1 postoperative infection was noted in patients with small defects (0.03%), while a 4.0% infection rate was noted for larger defects.

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culated using Excel (Microsoft) and SPSS Statistics software. We used Fisher exact test and χ 2 test to identify any statisti cally significant associated risk factors for complications. Fisher

342 JAMA Facial Plastic Surgery September/October 2016 Volume 18, Number 5 (Reprinted)

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