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Scarring reduced using local skin flap closure in Mohs surgery

The use of local skin flaps in Mohs micrographic surgery (MMS) appears to result in a lower Vancouver Scar Scale (VSS) rating at six months compared to full thickness skin graft (FTSG) or healing by second intention (SI), according to the results of a new study.

Published in The Journal of Clinical and Aesthetic Dermatology, this retrospective study evaluated scarring risk in 66 adults (18 years and older) who underwent MMS for basal cell carcinoma (BCC) on the distal third of the nose. Clinical images of MMS defects and postoperative scars at six months were recorded and measured using the VSS. All excisions were performed by a single surgeon between June 2019 and June 2020.

Of the 66 patients, 52 had low VSS (77.61%), 11 had medium VSS (16.42%) and three had high VSS (4.48%). In the group of 52 patients with low VSS, 40 had local flap (76.92%), nine had FTSG (17.31%), and three healed by SI (5.77%), the authors noted.

There were 11 patients with medium VSS—two underwent local flap (18.15%), nine had FTSG (81.82%), and zero healed by SI. Of the three patients with high VSS, all had FTSG (100%). The authors noted that none of the scars required revision.

“Repair of nasal structures is particularly challenging due to the unique anatomy of the area, varying degrees of convexity and concavity in close proximity, and the relative paucity of redundant skin to utilize,” the authors wrote in their article.

“The goal of this study is to identify if there is a measurable difference in surgical outcomes, as determined by the VSS, between closures using a local skin flap, FTSG, or SI. There is no algorithmic process to assist in the decision.”

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