Aesthetic Outcomes of Nasal Reconstruction Following Mohs Excision

Nasal reconstruction following Mohs excision can be performed with several techniques. The authors sought to evaluate which procedures provided the most aesthetic results.

A retrospective review was conducted on patients who underwent primary nasal reconstruction by the senior author following Mohs excision over an 8-year period. Data collected included patient demographics, smoking status, defect size, reconstruction method, and photo documentation. Patients were categorized into the following 4 groups: full thickness skin grafts (FTSG), local skin flaps, cheek flaps, and paramedian forehead flaps. Postoperative photos were assessed by a blinded plastic surgeon using a Likert scale for aesthetic outcomes. Ordinal logistic regression models were used to assess the adjusted effects of reconstructive technique, age, sex, defect size, and smoking status on outcome ratings.

One hundred forty-four (144) cases met inclusion criteria. The average patient age was 65.3 years. Distribution included 42 FTSGs, 60 local flaps, 13 cheeks flaps, and 29 forehead flaps. Reconstructions using local skin flaps and forehead flaps were statistically more likely to be rated favorably compared to those using FTSGs [local flaps: odds ratio (OR) = 2.79 (1.29-6.17), P = 0.011; FTSGs: OR = 2.84 (1.05-7.86), P = 0.043]. Larger defects negatively affected outcomes [OR = 0.90, confidence interval = (0.23-0.81), P = 0.019] in addition to any smoking history [OR = 0.43, confidence interval = (0.82-0.98), P = 0.019].

Local skin flaps and forehead flaps provide favorable aesthetic results in comparison to FTSGs for nasal reconstruction.