Facial Reconstruction following Mohs Micrographic Surgery: A Report of 622 Cases

Background: Around 100 to 200 patients undergo surgical reconstruction every year at our department of plastic and reconstructive surgery after Mohs micrographic surgery for nonmelanoma skin cancer. Objective: The aim of this report is to provide an overview of the type of facial reconstructions performed and investigate whether we achieved increased, definitive closure rates of the defect on the day of the excision after further improving the collaboration between the involved departments. Methods: All patients who underwent facial reconstruction at the Department of Plastic and Reconstructive Surgery following Mohs micrographic surgery between January 2006 and January 2011 were retrospectively systematically reviewed. Results: A total of 564 patients with 622 defects were identified. The different reconstructions used per aesthetic unit are described. The number of cases in which a reconstruction was performed on the same day as the resection significantly increased from 31 to 81% ( p < .001). Conclusion: Facial reconstruction following Mohs micrographic surgery is challenging. The type of reconstruction used depends on the type of defect and patient characteristics. A structured multidisciplinary approach improves the process from defect to reconstruction and can facilitate referrals.

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A Retrospective Review of Reconstructive Options and Outcomes of 202 Cases Large Facial Mohs Micrographic Surgical Defects, Based on the Aesthetic Unit Involved

Journal of Cutaneous Medicine and Surgery ◽

10.1177/1203475415586665 ◽

2015 ◽

Vol 19 (6) ◽

pp. 580-587 ◽

Cited By ~ 10

Author(s):

Anne C. van Leeuwen ◽

Ayleen The ◽

Sanne E. Moolenburgh ◽

Ellen R.M. de Haas ◽

Marc A.M. Mureau

Keyword(s):

Multidisciplinary Approach ◽

Facial Skin ◽

Mohs Micrographic Surgery ◽

Micrographic Surgery ◽

Tumour Control ◽

Aesthetic Unit ◽

Facial Defects ◽

The Aesthetic ◽

Nasal Defects ◽

Reconstruction Time

Background: For optimal treatment of facial defects following Mohs micrographic surgery (MMS), the aesthetic unit principles should be applied. Often multiple staged procedures and revisions are necessary. Objective: To analyze the reconstructive options and outcomes for complex facial defects per aesthetic unit. Methods: Data of 202 patients, who underwent a facial reconstruction at the department of plastic and reconstructive surgery following MMS, were collected. Results: The central facial units were affected in more than 70%, with over 20% of the defects involving more than 1 unit. Nasal defects required the longest reconstruction time (3-staged forehead flap) and periocular defects the most revisional procedures. In more than 50%, additional operations (range, 1-5) were needed. In 12%, postoperative complications occurred. Conclusion: An overview for the reconstructive options of extensive facial skin cancer is presented. Proper treatment requires a structured multidisciplinary approach in order to achieve excellent tumour control and a satisfactory aesthetic and functional end result.

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A Multidisciplinary Approach to Penetrating Neck Trauma in a Patient with Self-Inflicted Gunshot Injuries to Zones 1-3 of the Neck

The American Surgeon ◽

10.1177/0003134820973357 ◽

2020 ◽

pp. 000313482097335

Author(s):

Timothy R. Chung ◽

Meredith Mishler ◽

William Aukerman ◽

Siddhartha Nannapaneni ◽

Daniel Urias ◽

...

Keyword(s):

Reconstructive Surgery ◽

Multidisciplinary Approach ◽

Trauma Surgery ◽

Surgical Reconstruction ◽

Neck Trauma ◽

Diaphragmatic Dysfunction ◽

Timely Initiation ◽

Plastic And Reconstructive Surgery ◽

Swallowing Dysfunction ◽

Penetrating Neck Trauma

Penetrating neck trauma comprises 5%-10% of all traumatic injuries in adults and carries up to a 10% mortality rate for those affected. Management of penetrating neck trauma can be challenging and often requires a multidisciplinary approach. A case of penetrating neck trauma via self-inflicted gunshot wound to zones 1-3 of the neck in an intoxicated, suicidal 60-year-old man is presented. Immediately after stabilization by the trauma surgery team, surgical reconstruction using a pectoralis major pedicled myocutaneous flap was completed by the plastic and reconstructive surgery team. The patient’s hospital course was complicated by injury to the left phrenic nerve, oropharyngeal swallowing dysfunction, and left diaphragmatic dysfunction. The trauma team initiated prompt multidisciplinary responses to each of these complications as they arose by involving the plastic and reconstructive surgery, otolaryngology, gastroenterology, and speech language pathology teams. Early involvement of the physical medicine and rehabilitation, psychiatry, dietary, and pharmacy teams allowed for early optimization and monitoring of the patient’s mobility, psychological, and nutritional statuses. The timely initiation of multidisciplinary care in this patient’s case allowed for the patient to not only to survive a potentially fatal penetrating neck trauma, but to be discharged to a rehabilitation facility with an independent level of function. Given the complications due to severe penetrating neck trauma of zones 1-3 in this case, it is essential for early involvement of the appropriate subspecialty teams in order to achieve the best possible outcome for the patient.

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