xRead - Facial Reconstruction Following Mohs Micrographic Surgery

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Archives of Dermatological Research (2023) 315:1853–1861

Introduction The periorbital region is a challenging location for reconstruc tion after removal of skin cancers because of the intricate anat omy, eyelid free margins, and importance of both functionality and cosmesis [1]. Periorbital reconstruction is performed by multiple specialties including dermatology, ophthalmology, plastic and reconstructive surgery (PRS), and otolaryngol ogy. Therefore, the literature on periorbital reconstruction is spread amongst the journals of these specialties. There are many articles on periorbital reconstruction after Mohs micro graphic surgery (MMS) or surgical excision, but the literature currently lacks a comprehensive systematic review of these reports. We herein provide the first comprehensive systematic review to our knowledge on periorbital reconstruction after MMS or surgical excision with the goals of organizing this data and identifying trends in the literature. Methods The study was registered with the PROSPERO database (CRD42019119967). A comprehensive search of eight data bases was performed using terms related to eyelid anatomy, MMS and excisions, and reconstructive methods. A complete search strategy is included as supplemental content. To be included in the study, full-text articles had to be published in English between 2005 and 2020 and contain four or more patients with MMS or excision defects in the periorbital region. Defects limited to the eyebrow or infraorbital cheek were excluded. Studies with fewer than four eligible patients, literature or systematic reviews, and abstract-only publica tions were excluded. After removal of duplicates from the initial database retrieval, abstracts were reviewed for poten tial inclusion by two study authors (KS, RG). The remaining articles underwent full text review by three study authors (KS, RG, LA), and any discrepancies were resolved by the senior author (IM). Data were extracted from each article including the authors’ medical specialties, study design, subject number and demographics, tumor location, tumor type, methods of cancer resection, defect characteristics, reconstructive tech niques, complications, outcome measures, and method of out come assessment. Tumor location was categorized as medial canthus, lateral canthus, upper eyelid, or lower eyelid using the locations listed in the reviewed articles. If a tumor spanned 2 or more of these zones, it was categorized as “multiple zones”. Results The initial database search yielded 2020 articles, including 736 duplicates which were removed. The titles and abstracts of the remaining 1284 articles were screened and 1077 were

excluded. The remaining 207 articles then underwent full text review which eliminated 154 articles (Fig. 1). Fifty three studies were included in the final analysis [2–54]. All articles were either case series or cohort studies. Only 5 studies were prospective (9%). The specialty of the first and last authors was most commonly ophthalmology (47%) or plastic/reconstructive surgery (23%), followed by derma tology (13%), otolaryngology (4%), or multispecialty col laborations (13%). Studies included an average of 91 patients (standard deviation 164). Basal cell carcinoma was the most common tumor type (89% of tumors), followed by squamous cell carcinoma (7%), melanoma (1%), and sebaceous carcinoma (1%). Other tumor types, each comprising < 1% of tumors, were Merkel cell carcinoma, microcystic adnexal carcinoma, or basosquamous carcinoma/metatypical cell carcinoma. Tumors were most commonly located on the lower eyelid or medial canthus (Fig. 2). Methods of tumor resection that were utilized included MMS (60% of articles), wide local excision (30%), or staged excision (19%).

Fig. 1 Process of article exclusion and reasons for exclusion. “Wrong outcome” included studies that did not include repair data for peri orbital defects. “Wrong study design” included studies that were lit erature reviews or systematic reviews. “Wrong population” included articles that did not have at least 4 patients with defects that were a result of removal of malignancy (e.g., studies with only defects related to trauma). “Wrong defect location” included articles that only had defects outside of the immediate periorbital areas (e.g., eyebrow, infraorbital cheek)

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