Delayed full-thickness skin grafts revisited.

Area of Science:

• Dermatology and Plastic Surgery
• Surgical Reconstruction
• Mohs Micrographic Surgery (MMS) Outcomes

Background:

• Mohs micrographic surgery (MMS) can result in complex surgical defects requiring reconstruction.
• Traditional options include immediate grafting or flap procedures, which may not be suitable for all patients.
• Delayed full-thickness skin grafting (FTSG) presents an alternative for select MMS defect management.

Purpose of the Study:

• To evaluate the efficacy and outcomes of delayed FTSG in repairing MMS defects.
• To compare delayed FTSG with immediate FTSG and other reconstructive methods.
• To assess the potential for secondary intention healing in MMS defects.

Main Methods:

• Retrospective review of 70 patients undergoing MMS with FTSG or scheduled for delayed FTSG over five years.
• Comparison of immediate and delayed FTSG outcomes based on graft loss, epidermal sloughing, contour, pigmentation, erythema, and revision rates.
• Analysis of photographic records for outcome assessment.

Main Results:

• Twenty-seven patients had immediate FTSG, and 20 had delayed FTSG (average 3.6 weeks post-MMS).
• Twenty patients, initially planned for delayed FTSG, healed by second intention with satisfactory cosmetic results.
• No significant difference in outcomes was observed between immediate and delayed FTSG groups.

Conclusions:

• Delayed FTSG is a practical option for MMS defects when immediate grafting or flap repair is not feasible.
• A significant proportion (over 50%) of complex MMS defects can achieve satisfactory cosmetic results through secondary intention healing.
• Delayed FTSG offers a valuable reconstructive strategy, potentially avoiding more complex surgical interventions.