Clinical Outcomes and Complications in Complex Closures Under Local Anaesthesia Post-Mohs Surgery.

IF 3.9 4区医学 Q2 DERMATOLOGY

Journal of Cutaneous Medicine and Surgery Pub Date : 2025-07-01 Epub Date: 2025-01-27 DOI:10.1177/12034754251316297

Somaira Nowsheen, Vy X Pham, Shaundra Eichstadt, Shang I Brian Jiang

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引用次数: 0

Abstract

Background: Mohs micrographic surgery offers high cure rates of cutaneous malignancies, but surgeons are often faced with large and complicated defects after tumour removal.

Objectives: To assess the safety and complication rates of large flaps and grafts (measuring ≥30 cm²) 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.

Methods: 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.

Results: 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).

Conclusions: 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.

Abstract Image

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mohs手术后局部麻醉下复杂闭合的临床结果和并发症。

背景：莫氏显微摄影手术对皮肤恶性肿瘤具有很高的治愈率，但外科医生在肿瘤切除后经常面临较大而复杂的缺陷。目的：评估大皮瓣和移植物（尺寸≥30 cm2）和更大的复杂线性闭合（CLC,≥12.5 cm，根据美国医学协会现行程序术语代码集定义）在局部麻醉下的安全性和并发症发生率。方法：回顾性分析2010年1月1日至2022年12月31日在某学术机构（UCSD）接受Mohs治疗的一组患者，这些患者的缺陷采用CLC、皮瓣或皮肤移植修复。收集并分析了人口统计、手术和并发症数据。结果：在符合纳入标准的436例患者中，39例行小细胞肺癌，344例行皮瓣重建，53例行移植。所有治疗方法均无局部麻醉不良反应。总并发症发生率为16.1%（70/436）。不同治疗方法的并发症不同，包括感染（6.0%,26/436）、出血（3.2%,14/436）、血肿（5.0%,22/436）、血肿（0.2%,1/436）和皮瓣/移植物坏死（6.5%,26/397）。结论：我们的数据表明，大CLC、皮瓣和移植物可以在局部麻醉下安全进行，但与较小的重建相比，并发症发生率更高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cutaneous Medicine and Surgery 医学-皮肤病学

CiteScore

3.70

自引率

4.30%

发文量

审稿时长

6-12 weeks

期刊介绍： Journal of Cutaneous Medicine and Surgery (JCMS) aims to reflect the state of the art in cutaneous biology and dermatology by providing original scientific writings, as well as a complete critical review of the dermatology literature for clinicians, trainees, and academicians. JCMS endeavours to bring readers cutting edge dermatologic information in two distinct formats. Part of each issue features scholarly research and articles on issues of basic and applied science, insightful case reports, comprehensive continuing medical education, and in depth reviews, all of which provide theoretical framework for practitioners to make sound practical decisions. The evolving field of dermatology is highlighted through these articles. In addition, part of each issue is dedicated to making the most important developments in dermatology easily accessible to the clinician by presenting well-chosen, well-written, and highly organized information in a format that is interesting, clearly presented, and useful to patient care.