Mohs Defect Reconstruction Surgery Overview
With this precise surgical mapping technique, complete tumor removal is achievable while maximizing normal tissue preservation. This is particularly important on the face to retain facial muscle and skin functionality as well as achieve the most pleasing aesthetic outcome. During Mohs surgery, thin layers of cancer-containing skin are progressively removed, one thin layer at a time, and examined until only cancer-free tissue remains. Unfortunately, there are instances when obtaining clear surgical margins results in significant post-surgical defects, and a plastic surgeon is often consulted afterward or even present during surgery.
Generally, the only doctors who perform Mohs surgeries are dermatologists. When Mohs surgery has been recommended, many people worry about scarring. Since the Mohs surgery requires the doctor to cut away the diseased tissue a bit at a time, sometimes the area can be quite large even without visible marks on the skin.
For this reason, some people want a board-certified plastic surgeon to assist with the procedure. Unfortunately, most plastic surgeons are not trained in the Mohs procedure, however, Dr. Michael K. Kim does a lot of Mohs closure once the cancer is removed.
Reasons for Reconstruction by a Board-Certified Plastic Surgeon after Mohs Surgery
Facial reconstruction is a powerful tool to repair unavoidable defects of the face after cancer surgery using Mohs. When performing facial reconstruction, proper patient evaluation, and execution of a thorough, anatomic-based treatment plan can produce safe, reliable, and satisfactory outcomes.
Facial reconstruction after Mohs is indicated for any patient wishing to undergo a more complete closure of their post-excisional wound than natural healing can provide. Reconstruction options are described to the patient and include an explanation of the techniques to be used, such as primary closure, skin grafts, local flaps, interpolated flaps, and free-tissue transfer. Additionally, other grafts (e.g., cartilage grafts) may be required when additional support is necessary to create a satisfactory reconstruction.
Mohs Surgery for Basal Cell Carcinoma (BCC) or Squamous Cell Carcinoma (SCC)
Mohs Reconstruction Surgical Techniques
Firstly, facial reconstruction after Mohs should not commence until the margin status is confirmed. Although Mohs reconstruction often occurs on the same day of the procedure (either by the same or different surgeon), delayed reconstruction may have equivalent and sometimes improved outcomes, especially when performing skin grafts or composite grafts.
Ultimately, the type of reconstruction has its basis on a multitude of factors, including the surgeon's skill level, the size of the defect, patient characteristics, patient expectations (if they want single-stage versus multi-stage corrections), along the location of the defect, such as the forehead, nose, cheek, and perioral region.
Dr. Michael K. Kim is highly skilled in reconstructive surgical techniques after Mohs and will consult before, during, and after the Mohs surgery. He will outline options to the patient and include an explanation of the techniques to be used, such as primary closure, skin grafts, local flaps, interpolated flaps, and free-tissue transfer. Additionally, other grafts (e.g., cartilage grafts) may be required when additional support is necessary to create a satisfactory reconstruction, and the patient is consulted to determine the best method for the best possible result.
All reconstruction procedures result in some scarring, which warrants postoperative attention. If an unsightly scar occurs after routine wound care, multiple methods exist to improve the appearance of the scar.
