Complication Rates in Delayed Reconstruction of the Head and Neck After Mohs Micrographic Surgery

Area of Science:

• Dermatology
• Plastic Surgery
• Oncology

Background:

• Same-day reconstruction after Mohs micrographic surgery (MMS) is not always feasible.
• Delayed closure of Mohs defects carries potential risks, leading to hesitancy in practice.
• Understanding complication predictors is crucial for optimizing patient outcomes.

Purpose of the Study:

• To determine the frequency of complications in patients undergoing delayed facial reconstruction post-MMS.
• To identify patient and surgical factors predicting these complications.

Main Methods:

• Retrospective, multi-institutional cohort study (1989-2012).
• Included patients with facial carcinomas treated with MMS and delayed reconstruction.
• Complications were classified as immediate or delayed; multivariable logistic regression was used.

Main Results:

• A total of 415 cases were analyzed; the overall complication rate was 8.2%.
• Delayed reconstruction (>2 days), composite defects, and interpolated flaps with cartilage grafting were significantly associated with complications.
• Specific odds ratios: composite location (3.48), interpolated flap with cartilage (4.93), and delayed reconstruction >2 days (4.26).

Conclusions:

• Delayed facial reconstruction after MMS has a complication rate comparable to existing literature.
• Reconstruction delayed beyond two days, composite defects, and interpolated flaps with cartilage grafting increase complication risk.
• These findings aid in patient selection and surgical planning for delayed reconstructions.