Affiliation:
1. Department of Otolaryngology – Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO, USA
Abstract
Study Design Retrospective cohort study. Objective To determine patient, defect, and surgical factors associated with facial reconstructive outcomes. Methods Post-Mohs Micrographic Surgery (MMS) facial reconstructions performed at a single institution between 2015-2020 were reviewed. Patient demographics, comorbidities, defect characteristics, type and timing of reconstruction, and postoperative complications and revisions were collected. Data was analyzed with multivariable logistic regressions. Results 245 defects in 220 patients (median age 66 years, 143 (65%) female) were included. Most were located on the nose (68%), and median size was 3.0 cm2 (IQR 1.32-7.5 cm2). Defect size over 10 cm2 (OR 5.176, 95% CI 1.353-19.808) and two-staged melolabial flaps (OR 4.021, 95% CI 1.525-10.603) were associated with complications after univariate analysis. Nasal tip defects (OR 2.324, 95% CI 1.076-5.019) were associated with minor revisions. Major revisions were associated with nasal sidewall (OR 2.873, 95% CI 1.125-7.336) and tip (OR 2.780, 95% CI 1.145-6.749) defects, ear cartilage grafts (OR 3.373, 95% CI 1.382-8.231), two-staged paramedian forehead flaps (OR 19.273, 95% CI 6.864-54.112), and delayed reconstruction over 14 days (OR 5.727, 95% CI 1.298-25.281). On multivariable analysis, defect size over 10 cm2 (aOR 4.972, 95% CI 1.286-19.073) and two-staged melolabial flaps (aOR 4.575, 95% CI 1.628-12.857) were independently associated with complications, while two-staged paramedian forehead flaps (aOR 14.421, 95% CI 3.976-52.310) were independently associated with major revisions. Conclusions More complex reconstructions with larger defects and interpolated flaps were associated with revision surgery and complications of facial reconstruction following MMS.