Repair of a large wound of the back, post-Mohs micrographical excision, using chronic skin expansion

Large defects not otherwise closed primarily may be closed after chronic skin expansion.

If chronic expansion were deemed indicated for the closure of a proposed defect expected to result from Mohs micrographic surgery, can it be performed before Mohs surgery, avoiding the increased chance of expander extrusion via the defect when done postoperatively?

A team approach of a Mohs surgeon and a plastic surgeon coordinated scheduling an insertion of and staged infiltration of a tissue expander before Mohs surgical removal of a large basal cell carcinoma on the back of a young woman. The reconstruction after Mohs surgery was scheduled for the immediate postoperative period.

The Mohs surgery completed removed the carcinoma, and the expander was removed, enabling the surgeon to perform a side-to-side closure.

Provided that there is not a great probability of the neoplasm extending significantly deeper or wider than expected and that the skin expander is placed so as not to disturb the plane of Mohs excision, this is a useful technique to close large Mohs defects.