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Vol. 109. Num. 3.April 2018
Pages e13-e22Pages 197-292
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Vol. 109. Num. 3.April 2018
Pages e13-e22Pages 197-292
Original Article
DOI: 10.1016/j.ad.2017.10.007
Reconstructive methods in Mohs micrographic surgery in Uruguay: A bidirectional descriptive cohort analysis
Métodos reconstructivos en cirugía micrográfica de Mohs en Uruguay: una cohorte bidireccional descriptiva
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J. Navarrete
Corresponding author
jnavarrete90@gmail.com

Corresponding author.
, J. Magliano, M. Martínez, C. Bazzano
Cátedra de Dermatología Prof. Dr. Miguel Martínez, Hospital de Clínicas Dr. Manuel Quintela, Universidad de la República, Montevideo, Uruguay
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Tables (3)
Table 1. Main characteristics of cohort.
Table 2. Clinical lesion and defect areas according to anatomical site.
Table 3. Methods of closure used in different anatomical sites.
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Abstract
Background and objectives

The primary goal of Mohs micrographic surgery (MMS) is to completely excise a cancerous lesion and a wide range of reconstructive techniques of varying complexity are used to close the resulting wound. In this study, we performed a descriptive analysis of patients who underwent MMS, with a focus on wound closure methods.

Material and methods

We conducted a bidirectional descriptive cohort analysis of all MMS procedures performed by a single surgeon between November 2013 and April 2016. Cosmetic outcomes were photographically assessed by a dermatologist after a minimum follow-up of 90 days.

Results

We analyzed 100 MMS procedures in 71 patients with a median age of 73 years. The tumors were basal cell carcinoma (70%), squamous cell carcinoma (29%), and dermatofibrosarcoma protuberans (1%); 75% were located on the head and neck. The reconstructive techniques used were flap closure (48%), simple closure (36%), closure by second intention (11%), and other (5%). Cosmetic outcomes were assessed for 70 procedures (47 patients) and the results were rated as excellent in 20% of cases, very good in 40%, good in 20%, moderate in 17%, and bad/very bad in 2.9%. No significant associations were observed between cosmetic outcome and sex, Fitzpatrick skin type, hypertension, diabetes mellitus, or smoking. Worse outcomes, however, were significantly associated with larger tumor areas and defects, location on the trunk, and flap and second-intention closure.

Conclusions

Although there was a tendency to use simple wound closure for lesions located on the trunk and surgical defects of under 4.4cm2, the choice of reconstructive technique should be determined by individual circumstances with contemplation of clinical and tumor-related factors and the preference and experience of the surgeon.

Keywords:
Mohs micrographic surgery
Skin cancer
Basal cell carcinoma
Squamous cell carcinoma
Esthetics
Resumen
Introducción y objetivos

El principal objetivo cirugía micrográfica de Mohs es la excisión completa del cáncer de piel, dando lugar a una gran variedad de métodos reconstructivos de distinta complejidad. Objetivo: describir nuestros pacientes operados con cirugía de Mohs, enfocados a métodos de cierre.

Materiales y métodos

Cohorte bidireccional descriptiva de todas las cirugías de Mohs operadas por un mismo cirujano desde noviembre 2013 hasta abril 2016. Tiempo mínimo de 90 días de seguimiento para calificar estética, por un dermatólogo usando fotografías.

Resultados

Setenta y un pacientes y 100 cirugías individuales. Mediana para la edad: 73 años. 70% carcinoma basocelular, 29% carcinoma espinocelular y 1% dermatofibrosarcoma protuberans. 75% en cabeza y cuello. Métodos reconstructivos: colgajos 48%, cierre simple 36%, segunda intención 11%, otros 5%. 70 cirugías (en 47 pacientes) completaron seguimiento a largo plazo para evaluación de resultado estético: 20% excelente, 40% muy bueno, 20% bueno, 17% regular y 2.9% malo/muy malo. No hubo diferencias estadísticamente significativas entre resultado estético y el sexo, fototipo, hipertensión, diabetes mellitus o tabaquismo. Vimos una asociación estadísticamente significativa para peor resultado estético en mayores áreas y defectos, localización en tronco, reconstrucción con colgajo y segunda intención.

Limitaciones

Treinta pacientes se perdieron durante el seguimiento para calificar su resultado estético a los 90 días, el tiempo de evaluación fue altamente variable y no se registró la opinión del paciente.

Conclusiones

Aunque hubo una tendencia por escoger el cierre simple en tronco y defectos <4.4cm2, la decisión debe ser individualizada, considerando las características clínicas/tumorales y preferencia/experiencia del cirujano.

Palabras clave:
Cirugía micrográfica de Mohs
Cáncer de piel
Carcinoma
Basocelular
Carcinoma espinocelular
Estética
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