INTRODUCTION
Skin cancer is currently the most common type of cancer worldwide as it affects more than 3 million Americans annually.1 When feasible, many head and neck non-melanoma skin cancers (NMSC; basal cell carcinoma and squamous cell carcinoma) are treated surgically with Mohs micrographic surgery (MMS). As compared with wide local excision alone, MMS offers a lower local recurrence rate for both primary and recurrent NMSC.2 After tumor extirpation, MMS defects often require surgical reconstruction.3 Reconstructive options in the head and neck are numerous and include primary closure or adjacent tissue rearrangement with local flaps or skin grafts.
Recent literature has shown the excellent safety profile of Mohs surgery, with complication rates of less than one percent in large database reports. In a large 2012 review by Alam et al of 20, 821 MMS procedures, common adverse events reported were infections (61.1% of complications), dehiscence or wound necrosis (20.1%), and bleeding/hematoma.4 Clinical predictors of postoperative complications traditionally include smoking status, diabetes, concomitant anticoagulation, and the use of interpolated flaps with cartilage grafting.5 Additionally, it is well documented that MMS procedures may require revision in order to optimize cosmesis. A 2013 observational study indicated that patients with skin cancer had persistent concerns about their physical appearance 1-2 weeks postoperatively with fluctuations in self-reported quality of life.6 Indeed, cosmesis is a primary concern of patients, given that these excisions and repairs are performed on a highly visible and cosmetically sensitive areas of the body.
Prior studies have identified putative surgical risk factors for complications post-MMS, including defect location and closure type. Sclafani et al noted that reconstruction of the nasal ala subunit was independently associated with complications- including pin cushioning and the need for adjuvant corticosteroid treatment.7 Similarly, a recent retrospective review by Lee et al comprising 418 patients noted that 91% of nasal reconstructions post-Mohs involved either skin grafting or local/regional
Recent literature has shown the excellent safety profile of Mohs surgery, with complication rates of less than one percent in large database reports. In a large 2012 review by Alam et al of 20, 821 MMS procedures, common adverse events reported were infections (61.1% of complications), dehiscence or wound necrosis (20.1%), and bleeding/hematoma.4 Clinical predictors of postoperative complications traditionally include smoking status, diabetes, concomitant anticoagulation, and the use of interpolated flaps with cartilage grafting.5 Additionally, it is well documented that MMS procedures may require revision in order to optimize cosmesis. A 2013 observational study indicated that patients with skin cancer had persistent concerns about their physical appearance 1-2 weeks postoperatively with fluctuations in self-reported quality of life.6 Indeed, cosmesis is a primary concern of patients, given that these excisions and repairs are performed on a highly visible and cosmetically sensitive areas of the body.
Prior studies have identified putative surgical risk factors for complications post-MMS, including defect location and closure type. Sclafani et al noted that reconstruction of the nasal ala subunit was independently associated with complications- including pin cushioning and the need for adjuvant corticosteroid treatment.7 Similarly, a recent retrospective review by Lee et al comprising 418 patients noted that 91% of nasal reconstructions post-Mohs involved either skin grafting or local/regional
