Involving the patient is key in planning facial post-op repairs

Reconstructive Conundrums: A Patient-Centered Facial Subunit Approach to Post-Operative Repair (U018)

Mohs surgery is an effective tool for removing cancerous lesions with precise margin control, but it can leave patients with a variety of facial defects that require attention. Success in addressing these defects is not just the job of the surgeon. It requires a team effort in which the patient is a central participant.

Three Mohs surgeons in a Friday session will explore options for repairing post-operative defects on the forehead, eyelids, cheeks, lips, nose, and ears.

Focus on patient care
“This session has a spin toward a more patient-centered approach. Rather than unilaterally selecting a repair, we should ask, ‘What are patient-related factors we should consider?’” said the session director, Victoria Rose Sharon, MD. “Those considerations include age, health status, active medications, and mobility, among others.

“We can fix holes in many ways, but we should enlist patient considerations and preferences in selecting a repair.”

Treatment assumptions are often based on age, which can affect the patient’s overall health status.

“Some 90-year-olds, however, are quite active and concerned about cosmetic appearance, while others are not,” said Dr. Sharon, director of dermatologic surgery at Hofstra Northwell School of Medicine.

More practical considerations
Beyond aesthetics, there are practical considerations that affect recovery and follow-up visits:

  • Blood thinners affect the risk of post-operative bleeding, hematoma formation, infection, and wound separation. If a patient smokes or has diabetes, some repairs may be less optimal due to increased risk of failure.
  • Patient mobility and proximity to the office can affect their ability to travel for suture removal or post-operative wound checks. “If you have a choice between a fancy reconstructive repair versus a simple one in such circumstances, you may opt for the latter,” Dr. Sharon said.
  • Post-operative wound care depends on the extent and complexity of the selected reconstruction. If a patient will not be able to follow care instructions, another procedure should be considered. “Different types of reconstructions warrant varying levels of patient-related, post-operative wound care. Sometimes you can choose among a graft, flap, or second-intent healing, depending on the situation,” she said.
  • Physically active patients may prefer to leave wounds open rather than limit their activity. “Sometimes rather than suturing a wound closed, it is reasonable to leave it open to heal on its own,” Dr. Sharon said.

“The goal of the presentations is to learn how to approach post-operative Mohs defects while considering patient-related factors,” she said. “It is important to balance the patient’s priorities with the surgeon’s when thinking about post-operative reconstruction.”

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