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Pseudoaneurysm formation and repair after Mohs micrographic surgery: a report of 3 cases
1Division of Dermatology, Washington University in St Louis School of Medicine, St Louis, Missouri.
Importance:
Pseudoaneurysm is a well-known complication of trauma and iatrogenic injury to the vasculature. We report 3 cases of postsurgical pseudoaneurysm after Mohs surgery.
Observations:
Three patients who underwent Mohs surgery for nonmelanoma skin cancers presented between 2 and 4 weeks after surgery with several days' history of painful, enlarging, pulsatile subcutaneous masses. The lesions were diagnosed as postsurgical pseudoaneurysm. During surgical repair of each lesion, we identified vascular outpouchings that were connected to the injured arteries by sinus tracts. In all 3 patients, we ligated the affected artery and the neck of each lesion and reapproximated the skin. All wounds healed well without further recurrence.
Conclusions And Relevance:
Most reported cases of pseudoaneurysm formation in the head and neck involve the superficial temporal artery and its branches, and they typically occur secondary to blunt force trauma. Our cases are unique in that they included 1 case of a superficial temporal lesion but also 2 cases outside this system: 1 of the lateral nasal artery and 1 of the angular artery. We propose operative repair as the treatment of choice for facial pseudoaneurysms that complicate dermatologic surgery.
Insights
Postsurgical pseudoaneurysm, a rare complication of Mohs surgery, can present as painful masses. Surgical repair involving artery ligation effectively treated these cases, preventing recurrence.
Area of Science:
- Vascular Surgery
- Dermatologic Surgery
- Plastic Surgery
Background:
- Pseudoaneurysms are known vascular complications, often resulting from trauma or iatrogenic injury.
- Postsurgical pseudoaneurysms following Mohs surgery are infrequently reported.
- These lesions can manifest as painful, enlarging, pulsatile masses weeks after the procedure.
Purpose of the Study:
- To report three unique cases of pseudoaneurysm formation after Mohs surgery.
- To describe the clinical presentation, diagnosis, and successful surgical management of these rare complications.
- To highlight the potential for pseudoaneurysm formation in vessels beyond the superficial temporal artery system.
Main Methods:
- Case series of three patients presenting with postsurgical pseudoaneurysms after Mohs surgery for nonmelanoma skin cancers.
- Diagnosis confirmed by clinical examination and imaging (implied).
- Surgical intervention involved ligation of the affected artery and pseudoaneurysm neck, followed by skin closure.
Main Results:
- All three patients presented 2-4 weeks post-Mohs surgery with symptomatic pseudoaneurysms.
- Vascular outpouchings connected to injured arteries via sinus tracts were identified during repair.
- Successful surgical repair with artery ligation resulted in good wound healing and no recurrence in all cases.
Conclusions:
- Postsurgical pseudoaneurysms can occur after Mohs surgery, involving various facial arteries.
- Operative repair, including artery ligation, is an effective treatment for facial pseudoaneurysms complicating dermatologic surgery.
- This case series expands the understanding of pseudoaneurysm locations beyond the typical superficial temporal artery system.
