ISSN: 2639-2127
Authors: Driessen N*
Background: Mohs micrographic surgery (MMS) offers extreme precision and effectiveness when excising skin cancer. Careful reconstruction after Mohs surgery can minimize postoperative complications and determine the patient’s cosmetic outcome. There are several methods of reconstruction that a surgeon may opt for based on the defect size, location, depth, and the patient's skin laxity. The most common techniques for reconstruction after Mohs surgery are adjacent tissue transfer (ATT), full-thickness skin grafts (FTSG), and secondary intention (SI). All of these surgical techniques have proven to be safe and effective methods of reconstruction after Mohs surgery, however there is a long standing debate of which reconstructive technique produces the most desirable cosmetic outcomes. Methods: We report the case of a 78 year old female patient who underwent Mohs surgery and reconstruction at our practice, for three separate cases of basal cell carcinoma on the face. The first reconstruction was performed through ATT, the second through SI with the use of topical bovine collagen powder, and the third was closed through secondary intention with three applications of an amniotic graft. The outcomes were compared to assess if the reconstructive method after Mohs surgery has a significant impact on cosmesis. Verbal and written consent from the patient was obtained for publication. Results: The cosmetic results after reconstruction were graded as excellent, good, moderate, hypertrophied, or keloid, based on a modified Vancouver Scar Scale. Our findings showed that ATT produced a superior result compared to secondary intention with the use of collagen powder. The defect treated with the amniotic graft showed a faster wound healing rate compared to the defect closed by SI and collagen powder. Based on the wound closure rate and findings in related literature, we expect that the defect treated with the amniotic membrane will produce a more appealing cosmetic result than the defect treated with collagen powder.
Keywords: Mohs Micrographic Surgery; Adjacent Tissue Transfer; Secondary Intention; Amniotic Membrane
