Highlights from the Literature 1
Postoperative Complications After Interpolated Flap Repair for Mohs Defects of the Nose: A Multicenter Prospective Cohort Study
By Mariam Mafee, MD, FACMS
Interpolation flaps are more frequently performed by dermatologists compared to plastic surgeons and otolaryngologists (36.3% vs 32.4% vs 19.8% respectively).1 In the February 2023 issue of Dermatologic Surgery, authors report post-operative complications in the outpatient setting by performing a prospective cohort study of patients undergoing interpolated flap repair of post-Mohs nasal defects.
169 patients were enrolled over 8 academic institutions between October 2018 and March 2020. Patients were 18 years or older with skin cancer on the nose that was anticipated to require an interpolated flap repair. Those interpolated flaps that required greater than 2 stages, and those that were not anticipated to have an interpolated flap repair were excluded. The flaps performed were paramedian forehead flaps (42.6%), superiorly-based check to nose flaps (39.05%), and inferiorly-based check to nose flaps (18.34%). Very few repairs were delayed, as 98% of repairs were performed on the same day as the Mohs surgery. Of note, 76% of patients received prophylactic antibiotics at flap placement and 52% at takedown.
Complications were divided into those within 30 days of flap placement and those occurring within 30 days after flap takedown. Bleeding and infection were the most common complications, with most occurring during the first 30 days of the initial flap placement.
In the first 30 days of flap repair, 13.02% (22/169) of patients experienced 23 complications related to the surgery. Post-op bleeding occurred in 9 patients (5.33%), with 6 of those occurring in paramedian forehead flaps. Infection was noted in 7 patients (4.14%), with 5 occurring in cheek to nose flaps. Minor necrosis (1-10% of flap) was seen in 4 patients, and 2 patients had major necrosis (>10% of flap). One patient was hospitalized in relation to the surgery due to intractable hiccups secondary to antibiotic use. No dehiscence or death was noted.
In the 30 days after flap takedown, 3.55% (6/169) of patients experienced a complication. Infection occurred in 5 (2.96%) patients. One patient had minor necrosis (1-10% necrosis). No post-op bleeding, dehiscence, major necrosis, or death was noted.
Given that serious complications were rarely encountered, this study highlights the safety of interpolated flaps in an outpatient setting after Mohs surgery. Most complications occurred after the first stage of repair, which can help guide surgeons in setting expectations and counseling patients.
References:
- Lee MP, Giordano CN, Higgins HW II, Etzkorn JR. Trends in interpolated flap repairs on the nose, eyelids, ears, and lips after skin cancer excision in the United States from 2007 to 2016. Dermatol Surg 2021;47:285–6.