xRead - Facial Reconstruction Following Mohs Micrographic Surgery

The Journal of Craniofacial Surgery Volume 30, Number 2, March 2019

Facial Reconstruction After Mohs Surgery

range was not reported, it was calculated directly by the authors whenever possible.

TABLE 2. Search Terminology

Data Extraction and Analysis All identified citations were imported into EndNote X8.0.1 (Thomas Reuters, New York, NY). Included titles were subjected to a full-text screen. Inclusion and exclusion criteria are detailed in Table 3. Screening and data extraction were completed indepen dently by 2 authors (ARJ, SAE), and any disputes were resolved by discussion. If consensus could not be reached, a 3rd author was consulted for adjudication (WWW). Included articles were then classified into 3 categories according to main facial aesthetic unit of involvement. Criteria used to define each category are provided in Table 4. Data extracted included: study design, sample size, defect size and location, reconstructive technique, complications, follow up period, and patient-reported outcomes. If mean defect size or Human subjects only Entirely post-Mohs surgical population Post-Mohs reconstruction of defects involving the cheek, forehead and/or perioral region Full-text available Exclusion criteria Case studies Studies lacking complication information Studies not specifying complications per aesthetic zone involved Animal studies Technical studies detailing surgical techniques PubMed (1137 results) ((‘‘Mohs Surgery/methods’’[Mesh] OR ‘‘MOHS’’[tw] OR MOHs’[tw])) AND (((((((((‘‘Esthetics’’[Mesh]) OR (‘‘Surgical Wound Infection/analysis’’[Mesh] OR ‘‘Surgical Wound Infection/etiology’’[Mesh] OR ‘‘Surgical Wound Infection/ prevention and control’’[Mesh])) OR ‘‘Graft Rejection’’[Mesh]) OR ‘‘Graft Survival’’[Mesh]) OR ‘‘Ectropion/etiology’’[Mesh]) OR ‘‘Patient Satisfaction’’[Mesh]) OR ‘‘Treatment Outcome’’[Mesh]) OR (‘‘Reconstructive Surgical Procedures/adverse effects’’[Mesh] OR ‘‘Reconstructive Surgical Procedures/complications’’[Mesh] OR ‘‘Reconstructive Surgical Procedures/ methods’’[Mesh] OR ‘‘Reconstructive Surgical Procedures/therapeutic use’’[Mesh])) OR ‘‘Postoperative Complications’’[Mesh]) AND (‘‘Cheek/ surgery’’[Mesh] OR ‘‘Lip/surgery’’[Mesh] OR ‘‘Forehead/surgery’’[Mesh] OR ‘‘Facial neoplasms/surgery’’[Mesh] OR ‘‘Head and Neck Neoplasms/ Surgery’’[Mesh] OR ‘‘Skin neoplasms/surgery’’[Mesh] OR ‘‘Surgery, plastic/ methods’’[Mesh] OR ‘‘Wound closure techniques’’[Mesh])) EMBASE (519 results) ((("mohs micrographic surgery’’/exp OR mohs OR "micrographic surgical technique’’) AND ("face’’/exp OR facial OR cheek OR lip OR forehead OR perioral)) NOT (((‘‘mohs micrographic surgery’’/exp OR mohs OR ‘‘micrographic surgical technique’’) AND (‘‘face’’/exp OR facial OR cheek OR lip OR forehead OR perioral)) AND ‘‘case study’’/de)) AND ‘‘article’’/it AND ‘‘human’’/de Web of Science (521 results) (TS ¼ (Mohs) OR TS ¼ (Micrographic surgery)) AND (TS ¼ (Esthetics) OR TS ¼ (Surgical Wound Infection) OR TS ¼ (Graft Rejection) OR TS ¼ (Graft Survival) OR TS ¼ (Ectropion) OR TS ¼ (Patient Satisfaction) OR TS ¼ (Treatment Outcome) OR TS ¼ (Reconstructive Surgical Procedures) OR TS ¼ (Postoperative Complications)) TABLE 3. Inclusion and Exclusion Criteria Inclusion criteria

RESULTS

Study Characteristics Initial searches yielded 2177 citations. After title and abstract screening, 52 full-text articles were reviewed. Of these, 31 studies did not meet inclusion criteria. The main reason for article exclusion was a heterogeneous patient cohort which included non-Mohs surgical patients. Ultimately, 21 articles met the above-mentioned criteria (Fig. 1). Cheek: Overview of Studies Articles meeting inclusion criteria for cheek reconstruction included 8 retrospective reviews and 1 case series (Table 5). The average sample size was 113 patients. Mean defect size was 11.27 cm 2 . Patient follow-up information was reported in 44% of studies. The most frequently used reconstructive procedure for cheek defects was a cervicofacial advancement (CFA) flap. Direct linear closure, healing by secondary intention, other local flaps, and skin grafts were also described. Complications occurred in 7 of 9 studies and are detailed in Table 5. Patient satisfaction measures were described in 1 study. Cheek: Reconstructive Techniques Direct linear closure was the preferred reconstructive technique in all areas of the cheek. This approach was frequently used in combination with a postoperative scar management program for defects up to 4 cm in diameter. 17 Healing by secondary intention was described in 1 study for defects averaging 5.87 cm 2 . 13 TheCFA flaps were described in 50% of studies for closure of medium to larger-sized defects (mean ¼ 21.35 cm 2 , standard deviation 17.95) or defects spanning multiple aesthetic subunits. 16,18,20 Studies describing the CFA differed in their plane of dissection and placement of incision. 11,16,18,20 Inferiorly based rotation flaps

TABLE 4. Definitions of Aesthetic Subunits

Cheek : The cheek was defined by the pre-auricular crease laterally, the nasolabial fold medially, the zygomatic arch superiorly, and the mandible inferiorly. 11 Forehead : The forehead was defined by the temporal grooves laterally, the frontonasal groove inferiorly, and the hairline superiorly. 12 Perioral region : The perioral region was defined by the nasal base superiorly, the mental crease inferiorly, and the melolabial creases laterally. 3

FIGURE 1. Flow diagram of studies included and excluded from analysis.

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# 2018 Mutaz B. Habal, MD

Copyright © 2019 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.