When the final stage of Mohs Micrographic Surgery is found to be free of tumor, your skin cancer has been removed with a 99% cure rate for primary tumors and over 95% for recurrent tumors (previously treated but then came back). You are left with a skin defect that has clean margins (free of skin cancer). The Mohs Micrographic Surgery phase of your procedure is completed.
The next phase of your procedure is the skin reconstruction. The reconstruction phase is where Mohs surgeons and other reconstructive surgeons can differ significantly in their approach and final results. Dr. Morganroth is an expert at skin reconstruction, especially of the nose, ears, lips, and facial defects, and will utilize highly advanced reconstruction techniques to provide a natural cosmetic result with minimal scarring. Dr. Morganroth trains dermatologic surgeons, facial plastic surgeons, and oculoplastic surgeons in his reconstruction techniques on a routine basis.
Dr. Morganroth and his surgical associates offer 5 options for the repair of the Mohs defect:
1. allow the defect to heal in on its own
2. close the defect in a straight line
3. utilize a flap closure
4. utilize a graft closure
5. utilize a combination of 1 though 4.
A flap repair involves the mobilization and stretching of tissue adjacent to the defect. A graft consists of the removal of skin from a distant site (i.e. in front or behind the ear) and replacing it over the defect. Dr. Morganroth and his associate surgeons rely primarily on unique flap reconstructions to provide the best cosmetic result. Adjacent skin used in the flap repair matches the thickness, color, and texture of the missing skin, whereas the graft skin removed from another facial area will not match exactly in thickness, color, or texture. Allowing the defect to heal without reconstruction can take 3 to 12 weeks of daily wound care and produce unpredictable scarring ranging from excellent to an unacceptable cosmetic result. Dr. Morganroth and his surgical associates favor flap reconstruction with suture removal after one week with a predictable scar over allowing the defects to heal in on their own. Linear closure is preferable in certain facial regions, however flap repairs that create broken and geometric scars (Z-shaped, L-shaped) provide a superior cosmetic result. Linear scars that cross facial creases are much more obvious than broken lines and are more likely to spread over time.
Another important component of advanced reconstructive surgery is the meticulous suturing of the skin. Dr. Morganroth and his surgical associates emphasize the use of buried or subcutaneous sutures in his closures. These buried sutures dissolve over a one to three month period and allow the skin edges to form a strong bond that will prevent delayed spreading of the scar (commonly seen in wounds closed with only top or superficial sutures). When placed properly, buried sutures will completely close the wound edges so that superficial sutures can be used to perfectly align the skin edges. Well-aligned skin edges seen on day one will result in a barely visible scar down the line. Since the wound tension is handled completely by the buried sutures, the top sutures can be removed in one week or less and will not cause the “railroad track” scars commonly seen with inferior stitching techniques. Scars typically heal over a 12 month period of time, however these suturing techniques can produce remarkable visual resolution of scars within six weeks or less. Scars do take over 12 months to mature and will improve over this time period.
Please contact one of our physicians or our nursing staff if you have any questions regarding the skin reconstruction process or to schedule your consultation now.