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Original Investigation
September 7, 2017

Association of Mohs Reconstructive Surgery Timing With Postoperative Complications

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, University of Virginia Health System, Charlottesville
  • 2University of Virginia School of Medicine, Charlottesville
JAMA Facial Plast Surg. Published online September 7, 2017. doi:10.1001/jamafacial.2017.1154
Key Points

Question  Does delaying Mohs reconstructive surgery increase the risk of postoperative complications?

Findings  In this cohort study, a multivariable binary logistic regression model demonstrated that smoking status, defect size, full-thickness defects, interpolated flaps with cartilage grafting, and composite grafts were associated with an increased risk of postoperative complications. There was no association between timing of reconstruction and the risk of postoperative complications.

Meaning  These findings will allow surgeons the flexibility to plan the timing of reconstructive surgery so that it facilitates surgical planning, patient counseling, and scheduling issues.


Importance  Same-day Mohs reconstructive surgery is not always possible; moreover, a delay can offer benefits such as improved surgical planning and increased blood supply to the cauterized wound bed. However, recent work found that delaying reconstruction by more than 2 days increases the postoperative complication rate.

Objective  To review the outcomes of Mohs micrographic surgery (MMS) reconstruction with respect to patient- and surgery-specific variables, especially timing of repair.

Design, Setting, and Participants  Retrospective, single-institution cohort study of patients who underwent Mohs reconstructive surgery by 1 of the 2 senior authors from January 2012 to March 2017 for cutaneous squamous cell carcinoma or basal cell carcinoma. No patients had to be excluded for inadequate follow-up or incomplete medical records.

Main Outcomes and Measures  Postoperative complications including hematoma, infection, dehiscence, and partial or full graft or flap loss.

Results  A total of 633 defects in 591 patients (median [range] age, 65 [21-96] years; 333 [56.3%] female) were identified over the 5-year period. Reconstructions occurred from less than 24 hours to 32 days after MMS, with 229 (36.2%) delayed longer than 48 hours. Patient-specific variables reviewed included comorbidities, age, smoking status, and use of anticoagulant or antiplatelet medications. Surgery-specific variables analyzed included location and size of defect, time interval between MMS and reconstruction, and reconstructive modalities. Single-variable analysis was performed to determine whether each variable was associated with postoperative complications. On multivariable binary logistic regression, smoking status (odds ratio [OR], 2.46; 95% CI, 1.29-4.71; P = .007), defect size (OR exp(B), 1.04; 95% CI, 1.01-1.06; P = .006), full-thickness defects (OR, 1.56; 95% CI, 1.08-2.25; P = .02), interpolated flaps with cartilage grafting (OR, 8.09; 95% CI, 2.65-24.73; P < .001), and composite grafts (OR, 6.35; 95% CI, 2.25-17.92; P < .001) were associated with an increased risk of postoperative complications.

Conclusions and Relevance  We found no association between timing of Mohs reconstructive surgery and complications, indicating that a delayed repair did not increase the risk of infection or flap failure. Variables associated with an increased risk of postoperative complications include smoking status, size of the defect, full-thickness defects, interpolated flaps with cartilage grafting, and the use of composite grafts.

Level of Evidence  3.