Nowsheen Somaira, Pham Vy X, Eichstadt Shaundra, Jiang Shang I Brian
Department of Dermatology, University of California San Diego, San Diego, CA, USA.
J Cutan Med Surg. 2025 Jul-Aug;29(4):351-354. doi: 10.1177/12034754251316297. Epub 2025 Jan 27.
Mohs micrographic surgery offers high cure rates of cutaneous malignancies, but surgeons are often faced with large and complicated defects after tumour removal.
To assess the safety and complication rates of large flaps and grafts (measuring ≥30 cm) and larger complex linear closures (CLC, ≥12.5 cm, as defined by the American Medical Association Current Procedural Terminology code set), when performed under local anaesthesia.
A retrospective analysis was conducted on a cohort of patients who underwent skin cancer treatment by Mohs at an academic institution (UCSD) from January 1, 2010, to December 31, 2022, and whose defects were repaired with CLC, flap, or skin graft. Demographic, surgical, and complication data were collected and analyzed.
Of the 436 patients who met inclusion criteria, 39 underwent CLC, 344 underwent flap reconstruction, and 53 underwent grafting. Adverse effects to local anaesthesia were notably absent in all treatment methods. Overall complication rate was noted to be 16.1% (70/436). Complications varied across treatment methods, encompassing infection (6.0%, 26/436), bleeding (3.2%, 14/436), hematoma (5.0%, 22/436), seroma (0.2%, 1/436), and flap/graft necrosis (6.5%, 26/397).
Our data suggest that large CLC, flaps, and grafts can be safely performed under local anaesthesia, but have higher complication rates compared to smaller reconstructions.
莫氏显微外科手术对皮肤恶性肿瘤的治愈率很高，但外科医生在切除肿瘤后常面临大而复杂的缺损。
评估在局部麻醉下进行大皮瓣和移植物（尺寸≥30厘米）以及更大的复杂线性闭合术（CLC，≥12.5厘米，根据美国医学协会现行程序术语代码集定义）的安全性和并发症发生率。
对2010年1月1日至2022年12月31日在一所学术机构（加州大学圣地亚哥分校）接受莫氏皮肤癌治疗且缺损采用CLC、皮瓣或皮肤移植修复的患者队列进行回顾性分析。收集并分析人口统计学、手术和并发症数据。
在符合纳入标准的436例患者中，39例行CLC，344例行皮瓣重建，53例行移植术。所有治疗方法均未出现明显的局部麻醉不良反应。总体并发症发生率为16.1%（70/436）。不同治疗方法的并发症各不相同，包括感染（6.0%，26/436）、出血（3.2%，14/436）、血肿（5.0%，22/436）、血清肿（0.2%，1/436）以及皮瓣/移植物坏死（6.5%，26/397）。
我们的数据表明，大的CLC、皮瓣和移植物在局部麻醉下可以安全进行，但与较小的重建手术相比，并发症发生率更高。
