Facial Plast Surg 2024; 40(03): 370-377
DOI: 10.1055/a-2112-7073
Original Research

Time to Mohs Reconstruction: A Systematic Review Comparing Complication Rates between Immediate and Delayed Repair

1   Department of Otolaryngology–Head and Neck Surgery, Washington University in St. Louis, St Louis, Missouri
,
Allison Slijepcevic
2   Department of Otolaryngology–Head and Neck Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
,
Kim Lipsey
3   Bernard Becker Medical Library, Washington University in St. Louis, St Louis, Missouri
,
4   Department of Otolaryngology–Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine, St Louis, Missouri
,
Collin Chen
5   Department of Otolaryngology–Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Saint Louis University School of Medicine, St Louis, Missouri
› Institutsangaben

Abstract

Several known factors affect outcomes of Mohs facial defect reconstruction; however, the effect of repair timing on outcomes is ill-defined. The aim of this study was to determine postoperative complication rates between immediate and delayed repair of Mohs facial defects. Preferred Reporting Items of Systematic Reviews and Meta-Analyses guidelines were used. Articles were selected using PICO format—population: Mohs facial defect patients, intervention: defect repair, comparator: immediate (<24 hours), or delayed (>24 hours) repair, outcome: complication rate. PubMed/Medline (1946-2020), EMBASE (1947-2020), Scopus (1823-2020), Web of Science (1900-2020), Cochrane Library, and Clinicaltrials.gov were searched. Two independent reviewers screened abstracts; those in English with human subjects reporting repair timing and complication rates were included. Search criteria yielded 6,649 abstracts; 233 qualified for review. Data were gathered from six studies; they alone contained comparative data meeting inclusion criteria. While many well-written studies were encountered, reported results varied widely. A statistically sound meta-analysis could not be completed due to large heterogeneity between studies, biasing the analysis towards the largest weighted study. Clinically important differences may exist between immediate and delayed Mohs reconstruction, but small study numbers, large heterogeneity, and lack of standardized outcome measures limit definitive conclusions. More studies are needed to perform appropriate meta-analyses, including studies using standardized methods of reporting Mohs outcome data.



Publikationsverlauf

Accepted Manuscript online:
19. Juni 2023

Artikel online veröffentlicht:
27. Juli 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Rogers HW, Weinstock MA, Harris AR. et al. Incidence estimate of nonmelanoma skin cancer in the United States, 2006. Arch Dermatol 2010; 146 (03) 283-287
  • 2 Society AC. Facts & Figures 2022. Atlanta, GA: American Cancer Society; 2022
  • 3 Cameron MC, Lee E, Hibler BP. et al. Basal cell carcinoma: Epidemiology; pathophysiology; clinical and histological subtypes; and disease associations. J Am Acad Dermatol 2019; 80 (02) 303-317
  • 4 Aggarwal P, Knabel P, Fleischer Jr AB. United States burden of melanoma and non-melanoma skin cancer from 1990 to 2019. J Am Acad Dermatol 2021; 85 (02) 388-395
  • 5 Wong E, Axibal E, Brown M. Mohs Micrographic Surgery. Facial Plast Surg Clin North Am 2019; 27 (01) 15-34
  • 6 Vuyk HD, Lohuis PJ. Mohs micrographic surgery for facial skin cancer. Clin Otolaryngol Allied Sci 2001; 26 (04) 265-273
  • 7 Tierney EP, Hanke CW. Cost effectiveness of Mohs micrographic surgery: review of the literature. J Drugs Dermatol 2009; 8 (10) 914-922
  • 8 Sobanko JF, Sarwer DB, Zvargulis Z, Miller CJ. Importance of physical appearance in patients with skin cancer. Dermatol Surg 2015; 41 (02) 183-188
  • 9 Rankin M, Borah GL. Perceived functional impact of abnormal facial appearance. Plast Reconstr Surg 2003; 111 (07) 2140-2146 , discussion 2147–2148
  • 10 Brown BC, McKenna SP, Siddhi K, McGrouther DA, Bayat A. The hidden cost of skin scars: quality of life after skin scarring. J Plast Reconstr Aesthet Surg 2008; 61 (09) 1049-1058
  • 11 Lee EH, Klassen AF, Lawson JL, Cano SJ, Scott AM, Pusic AL. Patient experiences and outcomes following facial skin cancer surgery: a qualitative study. Australas J Dermatol 2016; 57 (03) e100-e104
  • 12 Brenner MJ, Moyer JS. Skin and composite grafting techniques in facial reconstruction for skin cancer. Facial Plast Surg Clin North Am 2017; 25 (03) 347-363
  • 13 David AP, Miller MQ, Park SS, Christophel JJ. Comparison of outcomes of early vs delayed graft reconstruction of Mohs micrographic surgery defects. JAMA Facial Plast Surg 2019; 21 (02) 89-94
  • 14 Wang CY, Dudzinski J, Nguyen D, Armbrecht E, Maher IA. Association of smoking and other factors with the outcome of Mohs reconstruction using flaps or grafts. JAMA Facial Plast Surg 2019; 21 (05) 407-413
  • 15 Goldminz D, Bennett RG. Cigarette smoking and flap and full-thickness graft necrosis. Arch Dermatol 1991; 127 (07) 1012-1015
  • 16 Higgins JPT, Thomas J, Chandler J. et al. Cochrane Handbook for Systematic Reviews of Interventions. Chichester (UK): John Wiley & Sons; 2019
  • 17 Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6 (07) e1000097
  • 18 Liberati A, Altman DG, Tetzlaff J. et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009; 339: b2700
  • 19 Patel SA, Liu JJ, Murakami CS, Berg D, Akkina SR, Bhrany AD. Complication rates in delayed reconstruction of the head and neck after Mohs micrographic surgery. JAMA Facial Plast Surg 2016; 18 (05) 340-346
  • 20 Sclafani AP, Sclafani JA, Sclafani AM. Successes, revisions, and postoperative complications in 446 Mohs defect repairs. Facial Plast Surg 2012; 28 (03) 358-366
  • 21 Mordick TG, Hamilton R, Dzubow LM. Delayed reconstruction following Mohs' chemosurgery for skin cancers of the head and neck. Am J Surg 1990; 160 (04) 447-449
  • 22 Lewis R, Lang Jr PG. Delayed full-thickness skin grafts revisited. Dermatol Surg 2003; 29 (11) 1113-1117
  • 23 Robinson JK, Dillig G. The advantages of delayed nasal full-thickness skin grafting after Mohs micrographic surgery. Dermatol Surg 2002; 28 (09) 845-851
  • 24 Thibault MJ, Bennett RG. Success of delayed full-thickness skin grafts after Mohs micrographic surgery. J Am Acad Dermatol 1995; 32 (06) 1004-1009
  • 25 Amici JM, Rogues AM, Lasheras A. et al. A prospective study of the incidence of complications associated with dermatological surgery. Br J Dermatol 2005; 153 (05) 967-971
  • 26 Vinding GR, Christensen KB, Esmann S, Olesen AB, Jemec GB. Quality of life in non-melanoma skin cancer–the skin cancer quality of life (SCQoL) questionnaire. Dermatol Surg 2013; 39 (12) 1784-1793
  • 27 Williamson P, Altman D, Blazeby J, Clarke M, Gargon E. Driving up the quality and relevance of research through the use of agreed core outcomes. J Health Serv Res Policy 2012; 17 (01) 1-2
  • 28 Porter ME, Larsson S, Lee TH. Standardizing patient outcomes measurement. N Engl J Med 2016; 374 (06) 504-506
  • 29 Rogers HW, Coldiron BM. Analysis of skin cancer treatment and costs in the United States Medicare population, 1996-2008. Dermatol Surg 2013; 39 (1 Pt 1): 35-42
  • 30 Rogers HW, Coldiron BM. A relative value unit-based cost comparison of treatment modalities for nonmelanoma skin cancer: effect of the loss of the Mohs multiple surgery reduction exemption. J Am Acad Dermatol 2009; 61 (01) 96-103
  • 31 Bialy TL, Whalen J, Veledar E. et al. Mohs micrographic surgery vs traditional surgical excision: a cost comparison analysis. Arch Dermatol 2004; 140 (06) 736-742
  • 32 Seidler AM, Bramlette TB, Washington CV, Szeto H, Chen SC. Mohs versus traditional surgical excision for facial and auricular nonmelanoma skin cancer: an analysis of cost-effectiveness. Dermatol Surg 2009; 35 (11) 1776-1787
  • 33 Rhee JS, Matthews BA, Neuburg M, Logan BR, Burzynski M, Nattinger AB. The skin cancer index: clinical responsiveness and predictors of quality of life. Laryngoscope 2007; 117 (03) 399-405
  • 34 Soh JM, Ibrahim SF, Tausk FA. Atypical surgical site infection after Mohs micrographic surgery in an immunocompetent individual. Dermatol Surg 2019; 45 (07) 1000-1002
  • 35 Xia Y, Cho S, Greenway HT, Zelac DE, Kelley B. Infection rates of wound repairs during Mohs micrographic surgery using sterile versus nonsterile gloves: a prospective randomized pilot study. Dermatol Surg 2011; 37 (05) 651-656
  • 36 Futoryan T, Grande D. Postoperative wound infection rates in dermatologic surgery. Dermatol Surg 1995; 21 (06) 509-514
  • 37 Messingham MJ, Arpey CJ. Update on the use of antibiotics in cutaneous surgery. Dermatol Surg 2005; 31 (8 Pt 2): 1068-1078
  • 38 Cho CY, Lo JS. Dressing the part. Dermatol Clin 1998; 16 (01) 25-47
  • 39 Dobbs TD, Samarendra H, Hughes S, Hutchings HA, Whitaker I. Patient-reported outcome measures for facial skin cancer: a systematic review and evaluation of the quality of their measurement properties. Br J Dermatol 2019; 180 (05) 1018-1029
  • 40 Surgery M. Mohs surgery: wound care considerations. Adv Skin Wound Care 2016; 29 (11) 486
  • 41 Edelman A, Foley M, McCall Jr M. 24-7 dressing technique to optimize wound healing after Mohs micrographic surgery. Cutis 2021; 107 (03) 149-150
  • 42 Veldhuizen IJ, Lee EH, Kurtansky NR. et al. To see or not to see: impact of viewing facial skin cancer defects prior to reconstruction. Arch Dermatol Res 2021; 313 (10) 847-853
  • 43 Lai YC, Parker C, Rogachefsky A, Lee K. Surgical planning for Mohs defect reconstruction in the digital age. Cutis 2022; 109 (05) 259-260
  • 44 Zitelli JA. Wound healing by secondary intention. A cosmetic appraisal. J Am Acad Dermatol 1983; 9 (03) 407-415
  • 45 Escobar V, Zide MF. Delayed repair of skin cancer defects. J Oral Maxillofac Surg 1999; 57 (03) 271-279 , discussion 279–280
  • 46 Ceilley RI, Bumsted RM, Panje WR. Delayed skin grafting. J Dermatol Surg Oncol 1983; 9 (04) 288-293
  • 47 Segal KL, Nelson CC. Periocular Reconstruction. Facial Plast Surg Clin North Am 2019; 27 (01) 105-118
  • 48 Kraft CT, Bellile E, Baker SR, Kim JC, Moyer JS. Anticoagulant complications in facial plastic and reconstructive surgery. JAMA Facial Plast Surg 2015; 17 (02) 103-107
  • 49 Kibbi N, Khan Y, Leffell DJ, Christensen SR, Suozzi KC. Predicting outcomes following second intent healing of periocular surgical defects. Arch Dermatol Res 2021; 313 (06) 483-489
  • 50 Mott KJ, Clark DP, Stelljes LS. Regional variation in wound contraction of Mohs surgery defects allowed to heal by second intention. Dermatol Surg 2003; 29 (07) 712-722
  • 51 Howe NR, Lang Jr PG. Daily observations during healing of a full-thickness human surgical wound by second intention. J Dermatol Surg Oncol 1991; 17 (12) 933-935