Deep-plane cervicofacial elevation superior for flap reconstruction after Mohs surgery

Deep-plane cervicofacial elevation was a superior technique for avoiding distal edge necrosis compared with subcutaneous cervicofacial elevation for flap reconstruction following Mohs ablative surgery, according to recent study results.

Researchers reviewed medical records of 88 patients (mean age, 65 years; 52% women) who underwent cervicofacial flap reconstruction for Mohs ablative surgery between January 2003 and June 2012. All procedures were conducted by one surgeon. Periorbital, midfacial, cervical and or lateral temporal/forehead defects were experienced by all patients after surgical ablation. Based on technique used, 69 patients (78%) were categorized in the subcutaneous (SC) cervicofacial elevation group and 19 patients were placed in the deep-plane (DP) cervicofacial elevation group.

Researchers reviewed the subcategories of smokers and nonsmokers, and distal edge necrosis (DEN) statistical analysis of the categories and subcategories was conducted.

For all patients, mean defect size was 14.3 cm2. Twenty-three percent of SC patients were active or recent smokers, while it was 11% among the DP group. Fifty-three nonsmokers in the SC group had a DEN rate of 23%, while 17 nonsmokers in the DP group did not have DEN (P=.03). There were 16 smokers in the SC group, with 12 having DEN, while the two smokers in the DP group did not have DEN (P=.09). The mean DEN area among SC patients was 0.8 cm2.

“The increase in operative time and technical difficulty make DP unappealing to a surgeon with limited experience,” the researchers concluded. “However, the merit of significantly less necrosis makes the DP technique an excellent choice for dissection of cervicofacial rotation-advancement flaps.

“Our statistically significant data indicate that DP dissection is a superior technique for avoiding DEN in nonsmokers. We found better outcomes in smokers as well. Thus, we strongly advocate the use of the DP approach as the criterion standard in cervicofacial flap elevation.”

Disclosure: The researchers report no relevant financial disclosures.