Unlocking the potential of direct closure in periocular reconstruction after Moh’s surgery: a case series.
Author: Giorgio Albanese
Base Hospital / Institution: Nottingham University Hospitals NHS Trust
ePoster presentation
Abstract ID: 24-374
Purpose
To report the effectiveness of the often underrated direct closure technique in the reconstruction of post-Mohs defects and to explain the technical nuances behind the success of this approach.
Methods
A retrospective notes review of all the patients who underwent direct closure by a single consultant surgeon (GA), following Moh’s micrographic surgery, from February 2020 to September 2023, was carried out. Patients who needed additional reconstructive techniques (e.g. local flaps, skin grafts) were excluded. Post-operative complications, surgeon’s and patients’ satisfaction were reported.
Results
Seventy-seven patients underwent direct closure as reconstructive technique following Moh’s surgery. Lower eyelid (n=37) and medial canthal area (n=22) were the most affected locations. The average maximal diameters of the defects were 16.86 x 13.28 mm. Post-operative complications occurred in 10 patients. Ectropion was the most common complication (n=4) and was successfully treated in all cases with eyelid massage. Webbing (n=1), wound dehiscence (n=1) and suture granuloma (n=1) were also managed conservatively. One patient developed trichiasis, which was treated with en-bloc excision of the eyelashes. Average surgeon’s and patients’ satisfaction was 8 and 9 out of 10 respectively. Mean follow-up was 8.9 months.
Conclusion
Direct closure is often underrated as reconstructive option. The reasons behind this lie in underestimation of physiological tissue expansion under tension and incorrect application of vectors. As opposed to direct closure following primary tumour excision, there is no report of this technique after Moh’s surgery, when size and shape of the defects can be unpredictable. The main advantages of direct closure include better cosmesis, less scarring, less operating time. Our results confirm that direct closure can achieve excellent results, both cosmetically and functionally, provided patient selection and surgical technique are appropriate.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Dalia | Zeinelabedien | Nottingham University Hospitals NHS Trust |
