Johnson Anna R, Egeler Sabine A, Wu Winona W, Bucknor Alexandra, Ibrahim Ahmed M S, Lin Samuel J
Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Department of Plastic Surgery, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
J Craniofac Surg. 2019 Mar/Apr;30(2):400-407. doi: 10.1097/SCS.0000000000005074.
Facial defects following Mohs surgery can cause significant functional, cosmetic, and psychologic sequelae. Various techniques for nasal reconstruction after Mohs surgery have been analyzed in the medical literature, yet there has been less attention given to procedures for other crucial facial aesthetic regions. A literature search using PubMed, EMBASE, and ISI Web of Science for studies assessing reconstructive techniques of the forehead, cheek, and perioral regions after Mohs surgery was performed. No limitations on date or language were imposed. Studies meeting inclusion criteria consisted of an entirely post-Mohs population, specified technique for aesthetic unit reconstruction, and detailed complications. The initial search yielded 2177 citations. Application of the author's inclusion and exclusion criteria resulted in 21 relevant studies. Linear closure was highlighted as the predominant technique when possible in all 3 aesthetic zones. Local flaps remained the workhorse option for cheek and forehead defects. Cheek and perioral reconstruction were associated with higher complication rates. Eighty-one percent of studies did not include patient-reported outcomes or standardized outcome measurement assessments. Mohs surgery has become a valuable approach for treatment of skin malignancies of the face. This review has identified significant study heterogeneity in methodology, design, and outcome assessment. Currently, there is no evidence-based literature to support an algorithm to guide surgeon choice of treatment in these 3 central areas. Recommendations are provided to improve the quality of future studies to better inform appropriate surgical technique for each facial unit analyzed.
莫氏手术后继发的面部缺损可导致严重的功能、美容和心理后遗症。医学文献中已对莫氏手术后各种鼻再造技术进行了分析，但对于其他关键面部美学区域的手术关注较少。利用PubMed、EMBASE和ISI科学网对评估莫氏手术后前额、脸颊和口周区域重建技术的研究进行了文献检索。未对日期或语言设置限制。符合纳入标准的研究包括完全为莫氏手术后的人群、美学单位重建的特定技术以及详细的并发症情况。初步检索得到2177条引文。应用作者的纳入和排除标准后，得到21项相关研究。在所有3个美学区域，线性缝合在可能的情况下被强调为主要技术。局部皮瓣仍然是修复脸颊和前额缺损的主要选择。脸颊和口周重建的并发症发生率较高。81%的研究未纳入患者报告的结果或标准化的结果测量评估。莫氏手术已成为治疗面部皮肤恶性肿瘤的一种有价值的方法。本综述发现，在方法、设计和结果评估方面存在显著的研究异质性。目前，尚无循证文献支持一种算法来指导外科医生在这3个中心区域选择治疗方法。本文提供了相关建议，以提高未来研究的质量，从而为所分析的每个面部单位选择合适的手术技术提供更好的依据。
