Linear Closure for Nasal Defects After Mohs Micrographic Surgery
January 2009 | Volume 8 | Issue 1 | Original Article | 23 | Copyright © January 2009
Adam J. Mamelak MD FRCPC, Steven Q. Wang MD, Leonard H. Goldberg MD FRCP
Background: Skin cancers on the nose are very common. Excision of these tumors results in surgical defects that can pose a chal- lenge to repair.
Objective: To present the authorsâ€™ experience of using linear closures (LC) to repair surgical defects on the nose in patients who underwent Mohs micrographic surgery (MMS).
Methods: A retrospective analysis was conducted of 4765 patients with skin malignancies on the nose that were treated with MMS between July 1997 and January 2006. The following variables were examined: type of repair, age, and sex of the patients, postopera- tive size of the defect, type of malignancy, location of the defect, and ﬁ nal length of the closure. Short-term and long-term complica- tions were evaluated and discussed. In a second study arm, a limited prospective cosmetic outcome assessment of patients with nasal defects repaired by LC compared to ﬂ aps and grafts was also conducted.
Results: There were 2053 patients (1020 men and 1033 women) who underwent LC of nasal defects after MMS. The average post- operative defect size was 1.7 X 0.9 cm, with an average closure length of 2.7 cm (range: 0.6 cm to 8.5 cm). The 2 major malignancies treated were basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) . Short-term complications were minimal. Nasal asym- metry and/or raising of the nasal alae were occasionally seen, which improved over time. The cosmetic outcomes of the LC group were rated higher than the ﬂ ap/graft group for lesions on the nose, although this was not statistically signiﬁ cant.
Conclusions: A vertical or slightly vertical linear closure for nasal defects after Mohs micrographic surgery is a robust and reliable method to deliver excellent cosmetic and functional results. Linear closure should be considered for small and mid-sized cutaneous nasal defects whenever possible.