A comprehensive preoperative decision-making tool for optimal surgical closure: CHAIRS

Area of Science:

• Dermatology
• Surgical Oncology
• Plastic Surgery

Background:

• Skin cancer excision and repair can be complex, particularly in the head and neck or with intricate closures.
• Optimizing decision-making requires explicit consideration and ranking of competing factors during the planning stage.
• The four hierarchical surgical goals are: cancer cure, avoiding functional disturbance, avoiding complications, and achieving good cosmesis.

Purpose of the Study:

• To design a memorable, formal process to aid doctors in considering and ranking surgical variables for skin cancer treatment planning.
• To develop an acronym that ensures the hierarchy of surgical importance is established before proceeding to the solution phase.

Main Methods:

• The development of the 'CHAIRS' mnemonic, representing Cure the Cancer; Hole; Area/Alignment; Icebergs/Incidents; Reservoirs; Solution(s)/Salvage.
• Implementing a structured approach to preoperative planning in skin cancer surgery.

Main Results:

• The CHAIRS mnemonic provides a framework for structured and orderly preoperative planning.
• It assists in ensuring all relevant variables are considered and ranked according to surgical importance.

Conclusions:

• CHAIRS facilitates favorable outcomes in skin cancer surgery through systematic preoperative planning.
• The mnemonic serves as a valuable learning tool for less experienced surgeons and a foundational reminder for experienced practitioners.
• CHAIRS is easily learned, remembered, and taught, promoting consistent application of best practices.