National Trends in Repair Type Selection After Mohs Micrographic Surgery: A Benchmark Analysis Using TriNetX.

Background: Following histologic tumor clearance in Mohs micrographic surgery, reconstruction plays a critical role in patient outcomes. Despite its importance, national-level data on real-world reconstructive patterns by anatomic site are lacking.

Objective: Characterize national repair patterns by anatomic site following Mohs micrographic surgery.

Methods: Using the TriNetX research network, we extracted Mohs micrographic surgery cases performed between 2006 and 2024 (N = 607,214) and categorized repairs into reconstructive classes using CPT groupings. Cases were stratified by anatomic subunit using ICD-10 codes. Temporal trends and statistical significance were assessed using chi-squared tests.

Results: Our analysis revealed the following distribution of repair types across all sites: complex repairs (34%), no same day repair (19%), local flaps (19%), intermediate repairs (18%), skin grafts (8%), interpolation flaps (0.8%), island pedicle flaps (0.1%), and simple closures (1.0%). Utilization of island pedicle flaps and complex repairs declined significantly over time (P<0.0001), coinciding with CPT coding revisions, while intermediate repair use increased. Local flaps, skin grafts, and no same day repair remained relatively stable but trended downward over time.

Conclusion: This study provides valuable insights for Mohs surgeons seeking to benchmark their own reconstructive practices as understanding one's practice patterns in relation to national norms is critical.