Evaluating the Effects of Timing of Reconstruction of Facial Mohs Defects for Nonmelanoma Skin Cancer on...

Background: Defects following Mohs micrographic surgery often require complex facial reconstruction, with timing varying between immediate (<24 h) and staged (>24 h) reconstruction. Objective: To compare the risk of postoperative complications between immediate and staged reconstruction of Mohs defects for facial nonmelanoma skin cancer (NMSC). Methods: Patients with NMSC who underwent Mohs and facial reconstruction were identified using a health network database (TriNetX). Complications including flap loss, skin necrosis, hyperpigmentation, hypertrophic scarring, infection, hematoma, seroma, dehiscence, overall complication, and revision surgery were compared at 1, 6, and 12 months postoperatively. Results: A total of 48,229 patients (mean [SD] age, 71.6 [11.5] years; 31,862 [66%] male) underwent immediate reconstruction, and 48,229 patients (71.5 [11.5] years; 31,997 [66%] male) underwent staged reconstruction. Immediate reconstruction had a lower risk of overall complication at 6 months postoperatively (odds ratio [OR]: 0.95, p = 0.04) and wound dehiscence (OR: 0.58, p < 0.001) at 1 month postoperatively but no difference in flap loss or hematoma. No difference in skin necrosis between groups at 6 months postoperatively was observed. At 12 months, immediate reconstruction demonstrated a lower risk of revision surgery (OR: 0.826, p < 0.0001). There was no difference in hypertrophic scarring or hyperpigmentation at 12 months postreconstruction. Conclusion: Although complications are rare, this study demonstrates advantages of immediate or staged defect reconstruction.