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

Mohs micrographic surgery offers high cure rates of cutaneous malignancies, but surgeons are often faced with large and complicated defects after tumour removal.

To assess the safety and complication rates of large flaps and grafts (measuring ≥30 cm²) and larger complex linear closures (CLC, ≥12.5 cm, as defined by the American Medical Association Current Procedural Terminology code set), when performed under local anaesthesia.

A retrospective analysis was conducted on a cohort of patients who underwent skin cancer treatment by Mohs at an academic institution (UCSD) from January 1, 2010, to December 31, 2022, and whose defects were repaired with CLC, flap, or skin graft. Demographic, surgical, and complication data were collected and analyzed.

Of the 436 patients who met inclusion criteria, 39 underwent CLC, 344 underwent flap reconstruction, and 53 underwent grafting. Adverse effects to local anaesthesia were notably absent in all treatment methods. Overall complication rate was noted to be 16.1% (70/436). Complications varied across treatment methods, encompassing infection (6.0%, 26/436), bleeding (3.2%, 14/436), hematoma (5.0%, 22/436), seroma (0.2%, 1/436), and flap/graft necrosis (6.5%, 26/397).

Our data suggest that large CLC, flaps, and grafts can be safely performed under local anaesthesia, but have higher complication rates compared to smaller reconstructions.