Complex Reconstruction
Complex reconstruction is required for many defects or wounds that result after tumor removal with Mohs Surgery. The goals of reconstruction are to restore function (for example breathing) and provide an elegant repair to set the stage for a cosmetically ideal outcome. It includes various techniques, including but not limited to flap and graft repair. For the best outcome, it is important to select a provider who regularly performs these procedures.
Dr. Findley performs complex facial reconstruction daily and has performed thousands of flap and graft closures, including multi-staged procedures such as the paramedian forehead flap.
What is Complex Reconstruction Surgery?
The decision on whether to stitch a wound together is made based on several factors. Our goal is always to provide the best functional and cosmetic outcome. In some circumstances, it is best to let a wound heal on its own (second intention healing). If letting a wound heal on its own may compromise the functional or cosmetic outcome, a more complex reconstruction approach may be required. This may include a skin or cartilage graft (often from nearby skin) or rearranging of the local tissue (flap repair). Sometimes, staged repairs are required where several procedures may be needed over 3-9 weeks or longer to restore normal anatomy (for example a 3-stage paramedian forehead flap repair).
When is Complex Reconstruction needed?
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Unfortunately, this may not be known until Mohs surgery is performed. As the roots and periphery of any skin cancer cannot reliably be seen with the naked eye, it is impossible to accurately determine the true size of the cancer, its depth of invasion and all the structures involved. The extent of the reconstructive requirements may vary greatly from a few stitches to advanced work such as cartilage grafts to rebuild nose structure, or even require more than one stage of reconstructive surgery.
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It is most ideal for the patient to have Mohs Surgery followed by the reconstruction performed in one setting on the same day. This is safer (under local anesthesia) and leads to a lower overall cost of the procedure.
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In most cases, the procedures are completed in the same operative setting allowing the patient to have all surgeries completed at the same appointment. In some cases, however, multiple procedures may be needed for the most ideal functional and cosmetic result. Our goal is to provide you with the simplest and most reliable means of repair, in a fashion that minimizes the risk of complications and maximizes the desired result.
Dr. Findley is able when necessary to coordinate your care with other specialists such as oculoplastics and radiation oncology.
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Our team will work with you to plan your reconstruction, starting with a detailed evaluation. This is essential to helping you understand what to expect, including the potential impact on the appearance and function of your skin and anatomy. Dr. Findley will assess your potential donor skin sites that are likely to produce the best results with minimal scarring. Dr. Findley may also close the surgical area by using surrounding tissue (local flap), or graft skin from another area of the body (skin graft).
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Our ultimate goal is to allow you to return to your normal daily life without limiting daily function or social interactions. However, healing is a complicated process that often takes up to one year for complete maturation of scars to occur. During this time, there may be a period when scars initially look worse before they look better. A completed final result may take more than one procedure or require small “touch ups” with various scar revision treatments to optimize the final appearance. All of this is factored into the selection of the reconstructive method chosen through a thorough discussion between you and Dr. Findley.