Management of large Mohs defects.

Area of Science:

• Dermatology
• Plastic Surgery
• Surgical Oncology

Background:

• Mohs surgery creates defects requiring closure.
• Management options include immediate closure, delayed reconstruction, or spontaneous healing.
• Optimal defect management balances cosmetic and functional outcomes.

Purpose of the Study:

• To evaluate the appropriateness of spontaneous healing versus surgical closure for head and neck Mohs defects.
• To compare cosmetic and functional results of different management strategies.
• To identify factors influencing the success of spontaneous wound healing.

Main Methods:

• Retrospective chart review and patient interviews for 185 patients with large head and neck Mohs wounds.
• Analysis of wound location, size, and depth.
• Periodic evaluation of cosmetic and functional outcomes at >= 6 months post-operation.

Main Results:

• Spontaneous healing yielded acceptable cosmesis for large scalp, neck, and ear defects (excluding through-and-through).
• Nasal defects typically require prompt reconstruction.
• Cheek, lip, and chin defects often had poor spontaneous healing cosmesis, but delayed repair of resulting scars can be less complex.
• Spontaneous healing can obviate or minimize complex surgical repair for selected defects.

Conclusions:

• Spontaneous healing is a viable option for selected Mohs wounds of the head and neck, offering satisfactory cosmetic and functional results.
• Effective management involves predicting spontaneous healing outcomes to reserve complex surgery for unfavorable results.
• This approach allows for efficient and effective selection of Mohs wound management strategies.