A comprehensive preoperative decision-making tool for optimal surgical closure: CHAIRS
Charles Ayesa1, Jeremy Hay2, Clara Jimenez Balcells3
1MBChB, BMedSci, FRNZCGP, FSCCA, General Practitioner, Upper Hutt Skin Clinic, Upper Hutt, New Zealand; College Censor, Skin Cancer College Australasia, Brisbane, Qld.
Background:
The process of excising and repairing skin cancers has the potential to be highly complex. This is especially the case on the head and neck or where a complex closure is required. To optimise decision making, it is important that at the planning stage all of the various, potentially competing, considerations are made explicit and appropriately ranked in relation to the four surgical hierarchical goals which are: (1) curing the cancer; (2) avoiding functional disturbance; (3) avoiding complications; and (4) achieving good cosmesis.
Objective:
We wished to design an easily remembered formal process that would not only assist doctors ensure they had considered all the relevant variables but that would also help rank these in terms of surgical importance prior to making a surgical plan. An appropriate acronym is an efficient means of ensuring the most important considerations are made explicit first (establishing the hierarchy) and that all the relevant information is gathered. Only then does the solution phase proceed. This is the basis of 'CHAIRS' which stands for: Cure the Cancer; Hole; Area/Alignment; Icebergs/Incidents; Reservoirs; Solution(s)/Salvage.
Discussion:
CHAIRS enables structured, orderly preoperative planning crucial for achieving favourable outcomes in skin cancer surgery. It provides less experienced doctors a framework to work with, and more experienced ones with a back-up first principles approach. It is easy to learn, remember and teach.
