Clinical Outcomes and Complications in Complex Closures Under Local Anaesthesia Post-Mohs Surgery.

Area of Science:

• Dermatology
• Surgical Oncology
• Plastic Surgery

Background:

• Mohs micrographic surgery achieves high cure rates for skin cancers.
• Large and complex defects often result from Mohs surgery tumor excisions.
• Reconstruction of these defects presents a surgical challenge.

Purpose of the Study:

• To evaluate the safety and complication rates of large reconstructions under local anesthesia.
• To assess large flaps (≥30 cm²), large grafts (≥30 cm²), and larger complex linear closures (CLC, ≥12.5 cm).

Main Methods:

• Retrospective analysis of 436 patients undergoing Mohs surgery reconstruction.
• Inclusion of defects repaired with CLC, flap, or skin graft.
• Collection and analysis of demographic, surgical, and complication data.

Main Results:

• No adverse effects from local anesthesia were observed.
• Overall complication rate was 16.1% (70/436).
• Common complications included infection (6.0%), flap/graft necrosis (6.5%), and hematoma (5.0%).

Conclusions:

• Large CLC, flaps, and grafts are safely performed under local anesthesia.
• These extensive reconstructions are associated with higher complication rates compared to smaller repairs.
• Careful patient selection and surgical technique are crucial for managing potential complications.