MedicalResearch.com Interview with:
Matthew Q. Miller, MD
Department of Otolaryngology–Head and Neck Surgery
University of Virginia Health System, Charlottesville
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Skin cancer is the most common type of cancer worldwide. In the United States, 3.3 million people are diagnosed with a new skin cancer annually and many of these individuals will have more than one cancer. The face is the most common place for skin cancers to develop. Mohs micrographic surgery (often referred to as Mohs surgery) is the standard of care for some skin cancers on the face. Once the cancer is removed, the skin defect is usually repaired by the Mohs surgeon but many require referral to a reconstructive surgeon.
We were intrigued by a recent publication that noted an increased risk in complications when repair of Mohs defects is delayed beyond 2 days. While most patients that will require referral for reconstruction can be predicted and scheduled accordingly in concert with the Mohs surgery, it is not infrequent that a Mohs procedure requires multiple, unexpected passes to excise the entire cancer and the patient is then left with an unexpectedly large defect requiring reconstruction. These large defects often require more OR time and planning and, therefore, reconstruction cannot be easily completed within 2 days of the Mohs procedure.
In our practice we perform a large number of Mohs reconstructive surgeries. We have not found that delaying repair beyond two days results in an increase in complications. Moreover, there are many occasions where we believe it is beneficial to delay longer than two days, e.g. to allow some granulation tissue to accumulate (which improves graft survival), to accommodate the patient’s schedule and prior commitments, or to give the patient a chance to recover and plan accordingly. We decided to examine our outcomes as they relate to timing of repair to ensure we are providing our patients with the best possible care.
We looked at all of our reconstructions over the past 5 years to see if delaying surgery is associated with infection, bleeding, or graft or flap failure; these are complications that could logically be related to the delay in repair. We reviewed more than 600 defects and looked at multiple variables.
We found NO association between the timing of facial reconstruction and whether the patient develops a post-operative complication that would be associated with a delay in repair.
MedicalResearch.com: What should clinicians and patients take away from your report?
Response: Our study supports the notion that delaying reconstruction will NOT affect post-operative outcomes. We hope this finding will help facial reconstructive surgeons counsel their patients in terms of options and timing. Similarly, we hope it will help patients feel comfortable in taking the time necessary to make reconstructive decisions when in discussion with their surgeons.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: There are plenty of questions left to be answered with regards to how best optimize Mohs reconstructive outcomes. Which patients require antibiotic prophylaxis after surgery? With increased rates of antibiotic resistance and antibiotic-associated diarrhea this question will become increasingly important for all surgical patients, Mohs reconstruction is not an exception. What is the best time to perform graft reconstruction after Mohs excision? More than 70% of the post-operative complications in our study were associated with a reconstruction including a skin, cartilage, and/or composite graft as opposed to flap-only reconstruction.
Our study demonstrates that delaying reconstruction does not affect post-operative outcomes. However, further research should elucidate whether there is an “ideal” interval between Mohs excision and graft reconstruction which optimizes post-operative outcomes.
Disclosures: None of the authors have any disclosures.
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Miller MQ, David AP, McLean JE, Park SS, Christophel J. Association of Mohs Reconstructive Surgery Timing With Postoperative Complications. JAMA Facial Plast Surg. Published online September 07, 2017. doi:10.1001/jamafacial.2017.1154
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