Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco.
Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville.
JAMA Facial Plast Surg. 2019 Mar 1;21(2):89-94. doi: 10.1001/jamafacial.2018.1204.
Reconstructing Mohs defects often requires grafting in the form of full-thickness skin grafts (FTSGs) and composite grafts. These grafts can be complicated by a variable and often indeterminable survival rate. Other researchers have found that delaying FTSG reconstruction improves graft outcomes, but the optimal interval between excision and reconstruction remains unclear, and no study has examined the association between delaying composite graft reconstruction and graft survival.
To review the outcomes of Mohs micrographic surgery defect reconstruction using FTSG and composite grafts with respect to patient- and surgery-specific variables, particularly early vs delayed reconstruction.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective, single-institution cohort study assessed patients who underwent Mohs reconstructive surgery from January 1, 2012, to January 1, 2018. No patients had to be excluded for inadequate follow-up or incomplete medical records. Delayed reconstruction was defined as greater than 6 days after Mohs excision, the third quartile of the interval to reconstruction among our cohort.
Primary outcome was postoperative complications, including hematoma, infection, dehiscence, epidermolysis, and partial or full graft loss.
A total of 320 defects were reconstructed with FTSG or composite grafts in 310 patients (median [range] age, 68 [21-96] years; 167 female [53.9%]) during the 6-year study period. The mean interval between the ablative and reconstructive operations was 4.73 days (range, 0-35 days). Univariate logistic regression was used to determine the significant indicators among patient and defect characteristics analyzed. A multivariate logistic regression model found delayed reconstruction to have a protective association (odds ratio, 0.52; 95% CI, 0.27-0.97; P = .046) and male sex to have a harmful association (odds ratio, 2.51; 95% CI, 1.52-4.20; P < .001) with postoperative complications.
This study found that delaying reconstruction in FTSGs and composite grafts was associated with decreased rates of postoperative complications, and male sex was associated with an increased risk of postoperative complications. The findings suggest that this strategy can be considered in patients at increased risk for developing postoperative complications, such as current smokers, patients with large defects, and patients who require use of composite grafts.
Mohs 缺陷的重建通常需要以全厚皮片移植（FTSG）和复合移植的形式进行。这些移植物的成活率存在差异，而且往往难以确定。其他研究人员发现，延迟 FTSG 重建可以改善移植物的结果，但切除和重建之间的最佳间隔时间仍不清楚，也没有研究探讨延迟复合移植重建与移植物存活率之间的关系。
回顾使用 FTSG 和复合移植物进行 Mohs 显微外科手术缺损重建的结果，重点关注患者和手术的特定变量，特别是早期与晚期重建。
设计、地点和参与者：这项回顾性、单机构队列研究评估了 2012 年 1 月 1 日至 2018 年 1 月 1 日期间接受 Mohs 修复手术的患者。没有患者因随访不充分或病历不完整而被排除。晚期重建的定义是Mohs 切除后超过 6 天，或者我们队列中重建间隔的第三四分位数。
主要结果是术后并发症，包括血肿、感染、裂开、表皮松解和部分或全部移植物丢失。
在 6 年的研究期间，共有 310 例患者（中位数[范围]年龄，68 [21-96] 岁；167 例女性[53.9%]）的 320 个缺陷用 FTSG 或复合移植物进行了重建。切除和重建手术之间的平均间隔时间为 4.73 天（范围，0-35 天）。使用单变量逻辑回归确定了分析中患者和缺陷特征的显著指标。多变量逻辑回归模型发现，晚期重建具有保护作用（比值比，0.52；95%CI，0.27-0.97；P=0.046），男性（比值比，2.51；95%CI，1.52-4.20；P<0.001）与术后并发症有关。
本研究发现，FTSG 和复合移植物的延迟重建与术后并发症发生率降低有关，而男性与术后并发症风险增加有关。这些发现表明，对于有发生术后并发症风险的患者，如当前吸烟者、有大面积缺损的患者和需要使用复合移植物的患者，可以考虑采用这种策略。
3 级。
