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Published on: June 20, 2018
Linear closure for nasal defects after Mohs micrographic surgery
Adam J Mamelak1, Steven Q Wang, Leonard H Goldberg
1DermSurgery Associates, Houston, TX 77030, USA.
Background:
Skin cancers on the nose are very common. Excision of these tumors results in surgical defects that can pose a challenge to repair.
Objective:
To present the authors' experience of using linear closures (LC) to repair surgical defects on the nose in patients who underwent Mohs micrographic surgery (MMS).
Methods:
A retrospective analysis was conducted of 4765 patients with skin malignancies on the nose that were treated with MMS between July 1997 and January 2006. The following variables were examined: type of repair, age, and sex of the patients, postoperative size of the defect, type of malignancy, location of the defect, and final length of the closure. Short-term and long-term complications were evaluated and discussed. In a second study arm, a limited prospective cosmetic outcome assessment of patients with nasal defects repaired by LC compared to flaps and grafts was also conducted.
Results:
There were 2053 patients (1020 men and 1033 women) who underwent LC of nasal defects after MMS. The average postoperative defect size was 1.7 x 0.9 cm, with an average closure length of 2.7 cm (range: 0.6 cm to 8.5 cm). The 2 major malignancies treated were basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Short-term complications were minimal. Nasal asymmetry and/or raising of the nasal alae were occasionally seen, which improved over time. The cosmetic outcomes of the LC group were rated higher than the flap/graft group for lesions on the nose, although this was not statistically significant.
Conclusions:
A vertical or slightly vertical linear closure for nasal defects after Mohs micrographic surgery is a robust and reliable method to deliver excellent cosmetic and functional results. Linear closure should be considered for small and mid-sized cutaneous nasal defects whenever possible.
Insights
Linear closure (LC) effectively repairs nasal defects after Mohs micrographic surgery (MMS). This method offers excellent cosmetic and functional outcomes for small to mid-sized skin cancers on the nose.
Area of Science:
- Dermatology
- Plastic Surgery
- Oncology
Background:
- Nasal skin cancers are common, and their surgical excision often results in defects that are challenging to repair.
- Mohs micrographic surgery (MMS) is a common treatment for skin cancers on the nose, frequently leading to surgical defects.
Purpose of the Study:
- To evaluate the authors' experience using linear closures (LC) for repairing nasal defects following MMS.
- To assess the cosmetic outcomes of LC compared to flaps and grafts for nasal defect repair.
Main Methods:
- Retrospective analysis of 2053 patients undergoing LC for nasal defects after MMS (July 1997-January 2006).
- Evaluation of defect size, closure length, malignancy type, defect location, and complications.
- Prospective assessment comparing cosmetic outcomes of LC versus flaps/grafts for nasal defects.
Main Results:
- LC was used on 2053 patients for nasal defects averaging 1.7 x 0.9 cm.
- Basal cell carcinoma and squamous cell carcinoma were the most common malignancies treated.
- Short-term complications were minimal, with occasional asymmetry that improved over time. Cosmetic outcomes for LC were rated higher than flaps/grafts, though not statistically significant.
Conclusions:
- Vertical or slightly vertical linear closure is a reliable method for excellent cosmetic and functional results in nasal defects after MMS.
- LC is a recommended technique for small to mid-sized cutaneous nasal defects post-MMS.
