Facial Reconstruction after Moh's Surgery
By Brian Kobienia, MD, FACS on September 01, 2012
Facial Moh’s Defect Reconstruction
Weekly I see patients in my office who have undergone surgery to remove skin cancers from their face. These folks often have a deer-in-the-headlights looks as they did not anticipate their skin cancer to be so big. They want restoration of their face without telltale signs of surgery, i.e. no scars.
When education folks about the options for reconstruction I explain to them all the possibilities and then help them pick the right technique for their particular problem. Often the location of the wound or the type of recovery desired helps make the decision as to which technique is best.
The options for reconstruction range from easy to difficult. The reconstructive ladder starts on the bottom rung. The easiest treatment is to nothing surgically and let Mother Nature heal the wound. The biggest advantage to this technique is that there is no need for surgery. The healing process takes some time and dressing changes will be necessary. Generally when picking this technique the wound either needs to be shallow to begin with or in an area where and indentation would be desirable, like at the junction of the nose and cheek.
Direct closure of the wound will enable quick healing, but at the expense of undergoing a surgery. This is a preferred treatment because of its simplicity but may not always be possible. Closure of a wound may alter the landscape too much. For example, if a wound on the nose is pulled together the nostril may be distorted. Nobody is happy looking like Ms. Piggy.
If direct closure is not possible, another option may be a skin graft. Stealing a piece of skin from another part of the face (in front of or behind the ear) can be used to reconstruct the skin cancer wound. The advantage of this is easy patching of the wound and a hidden donor site scar, but the skin graft may be of a different texture or color. Because of this, skin grafts work best in elderly patients and shallow wounds.
Flap closure is an option that will allow reconstruction of the wound using skin similar in color and texture to area where the cancer existed. This is like stealing from Peter to pay Paul. You are using nearby skin, keeping it attached to a blood supply, and rotating it into the wound. These flaps can be raised nearby, or can be harvested from a distance. An example of a more distant flap is the use of forehead skin to reconstruct the nose. The scar burden may be more but the texture,color, and thickness of the skin usually make the addes scars worth it.
Each of these options has its own inherent strengths and purposes. Remember, I’d rather not have to do any of these procedures on you so use your sunblock!
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