Mohs defect repairs involve the restoration of damaged tissue after a Mohs procedure, which is a medical technique used to treat skin cancer with precision, while minimizing the removal of normal healthy tissue. This technique is especially useful for high-risk skin cancers, such as those located on the head and neck, due to its high cure rates.
What is a Mohs defect?
A Mohs defect is the area left behind after a Mohs skin cancer procedure. This defect can vary in size from small to large and can be located in critical areas where aesthetics and functionality are important, such as the nose, eyelids, cheeks, forehead, or ears.
Why is Mohs defect repair necessary?
While Mohs surgery aims to remove all traces of skin cancer, occasionally, some cancer cells may remain at the edges or deep within the tissue. These remaining cells can compromise the integrity of the healing process, potentially leading to recurrence of cancer. Mohs defect repair is required to address these concerns and ensure that all cancer has been successfully removed.
Who performs Mohs defect repair?
Initially, Mohs defect repair may be performed by the same dermatologist who performed the Mohs procedure. However, in cases where larger defects or complex repairs are required, patients may be referred to a plastic or reconstructive surgeon or an ENT specialist trained to handle such reconstructive tasks.
What are the types of Mohs defect repairs?
1. Natural Healing
For small defects, where the skin is not significantly disfigured and can heal naturally, this option may be chosen. Natural healing by secondary intention involves allowing the body to fill in the defect with tissue, typically resulting in good cosmetic outcomes. However, this option may not be suitable for large defects or defects in critical areas.
2. Primary Closure
Primary closure, also known as first intention healing, involves reapproximating the skin edges and closing the defect without the need for a graft or flap. This method is commonly used for minor lacerations and surgical incisions but can also be applied to Mohs defects that are not too large or complex. Primary closure results in minimal scarring and a more natural-looking outcome.
3. Skin Grafting
When a significant amount of skin is lost, skin grafting may be necessary to fill in the defect. In this procedure, a small section of skin from another part of the body is removed and replaced over the harvested site. This can provide an excellent cosmetic outcome but may not always match the surrounding skin tone and texture.
4. Local Tissue Flaps (Adjacent Tissue Rearrangement)
Local tissue flaps involve rearranging existing tissues to fill in a defect. There are various types of flaps, including pivotal flaps, advancement flaps, transposition flaps, and bilobed flaps. These techniques utilize anatomy and geometric concepts to rearrange local tissues and allow for healing without the need for a larger incision. Flap survival relies on proper blood supply and surgical technique.
5. Advanced Reconstruction Techniques
For large defects that are not amenable to natural healing or primary closure, more advanced surgical techniques are required. Free flap tissue transfer involves taking a flap with an attached artery and vein from a donor site and transplanting it to the defect. These flaps are complex and are typically used for major reconstructive procedures rather than Mohs defect repairs.
##Mohs defect repairs are a crucial aspect of skin cancer treatment, ensuring that all cancer has been successfully removed and that the healing process is not compromised. Whether through natural healing, primary closure, skin grafting, local tissue flaps, advanced reconstruction techniques, or a combination of approaches, the goal of Mohs defect repair is to achieve optimal aesthetics and functionality while minimizing postsurgical complications.
