xRead - Facial Reconstruction Following Mohs Micrographic Surgery

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

Johnson et al

of which resolved with antibiotic therapy. 22,23 Only 1 study described patient-reported outcomes using a modified Likert scale. 23 Perioral Region: Overview of Studies Two case series and 7 retrospective review articles were included for the perioral region (Table 7). The average sample size was 30 patients. Mean defect size was the smallest reviewed at 2.41 cm 2 . Follow-up information was included in 67% of studies. Location and extension of defects in this region varied (Table 4). The most common reconstructive technique involved local and/or advancement flaps. The most common postoperative complication

was hypertrophic scarring, which occurred in 33% of all studies. Patient-reported outcomes were assessed in 2 studies.

Perioral Region: Reconstructive Techniques Direct linear closure was described less frequently for perioral reconstruction. It was used in 1 study for 73% of upper and lower lip defects measuring up to 3 cm in diameter. 17 Another study described an approach involving linear closure after composite resection for partial to full thickness defects involving up to 1/3 of the upper lip. 25 For small, partial thickness defects (mean ¼ 0.9 cm 2 ), simple vertical excision with primary closure was described. In this same study, excision of adjacent normal tissue followed by

TABLE 7. Summary of Perioral Study Characteristics

Study Design

Total Patients, n Defect Size

Defect Location

Reconstructive Technique

Follow-up Period

Inclusion of PROM

Study

Complications

3.05 cm 2 (mean)

Island pedicle flap Eclabium (n ¼ 1) Hypertrophic scarring requiring dermabrasion (n ¼ 3) Trapdooring

1–5 mo (range) No

Kaufman et al (1996) 24

RR 4

Philtrum

requiring steroid injection (n ¼ 2) Numbness (n ¼ 2) Misalignment of white roll requiring revision surgery (n ¼ 1)

Godek et al (1998) 25

1.70 cm 2 (mean)

164 d (mean)

Yes

RR 12

UL

Composite resection and linear closure

Gloster et al (2002) 26

2.50 cm 2 (mean)

UL: (n ¼ 2)

RR 13

Secondary intention Deformation of the vermilion border (n ¼ 1) LL TZ-transposition flap None reported

6 mo (mean)

Yes

LL: (n ¼ 11)

Trokel et al (2006) 27

RR 11

NS

Central and lateral LL

3 mo (minimum) No

2.60 cm 2 (mean)

FTSG (n ¼ 4)

Housman et al (2008) 28

CS

6

Philtrum

Pigmentary

3–49 mo (range) No

Island pedicle flap (n ¼ 2) Advancement flap (n ¼ 1)

discrepancy (n ¼ 1) FTSG Eclabium (n ¼ 1) FTSG Scarring requiring dermabrasion (n ¼ 3) FTSG reaction (n ¼ 6): CFA-S: (n ¼ 5), CFA-M: (n ¼ 1) Hypertrophic scarring (n ¼ 22): CFA-S: (n ¼ 14), CFA-M: (n ¼ 8) Pyogenic granuloma (n ¼ 2) CFA-S (n ¼ 1), CFA-M (n ¼ 1):

RR 138

3cm

UL and LL

Direct linear closure (73%)

None

NS

No

Soliman et al (2009) 17

(maximum diameter)

1–3 cm 2 (range)

CFA-S (n ¼ 16)

NS

No

Johanson-Johangir et al (2012) 29

RR 33

Central UL

Foreign body

CFA-M (n ¼ 17)

Huilgol et al (2014) 30

2.30 cm 2 (mean)

UL: (n ¼ 8)

CS

10

Double island

Hypertrophic scarring

No

LL: (n ¼ 2)

pedicled flap

(n ¼ 2) UL þ LL Postoperative

bleed requiring flap takedown (n ¼ 1) LL Vermilionectomy (n ¼ 1) LL

Jacono

RR 7

1.2–2.1 cm

Central UL

Bilateral

None

8 mo (mean)

No

et al (2015) 31

(range of diameter)

transposition flap

CFA, cervicofacial advancement flap; CFA-M, modified cervicofacial advancement flap; CFA-S, unmodified cervicofacial advancement flap; CS, case series; FTSG, full thickness skin graft; LL, lower lip; NS, not stated; PCAF, perialar crescenteric advancement flap; PROM, patient-reported outcome measure; RR, retrospective review; SC, subcutaneous plane dissection was used; UL, upper lip.

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# 2018 Mutaz B. Habal, MD

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