What Happens During Post-Mohs Reconstructive Surgery

Post-Mohs surgery is a type of reconstructive plastic surgery that can be done after skin-cancer lesions are removed with Mohs surgery. This reconstruction is done to optimize the appearance of the skin after surgery.

Surgeon in operating room
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Reconstruction Options

Several techniques can be used during post-Mohs reconstructive surgery. The techniques that your surgeon selects would be based on the location, size, and type of skin cancer that you have.

Techniques include:

  • Flap techniques: The most commonly used technique in post skin cancer facial reconstruction, a flap technique uses a piece of tissue that has a good vascular supply.
  • Bone grafting: Bone is most often taken from the skull and shaped to be placed into the excision site.
  • Cartilage grafting: The most common donor site for cartilage in the ear, but rib cartilage is also used.
  • Tissue expansion: Tissue expanders involve the placement of material under the skin to expand and promote the growth of your tissue, and they are used for a small percentage of people after Mohs surgery.
  • Skin grafts: Skin grafts are areas of skin that are removed from one region of the body and placed in another–they are used infrequently for facial reconstruction.

How It’s Done

Prior to your surgery, your surgeon will make sure you thoroughly understand the goals of the procedure, as well as the possible risks. You will be asked to sign an informed consent form stating that you understand the reason for the procedure and the possible complications that could occur.

You will also be given information about how to prepare for your procedure. This may include fasting from eating and drinking for a period of time before surgery (possibly overnight if you are having general anesthesia). You might also be instructed to stop taking blood thinners before your procedure. And your surgeon may tell you to shower the night before using a special soap.

On the day of your procedure, your skin cancer will be excised (removed) either by a dermatologist or by the plastic surgeon who will do your post-Mohs reconstruction.

Anesthesia

Skin cancer reconstruction may be performed with pain control using local anesthesia, intravenous sedation (also known as conscious sedation or "twilight sleep"), or general anesthesia (you would be fully asleep). Your doctor will recommend the best choice for you, based on the procedure you are having, as well as any other medical conditions you may have.

Lesion Resection

This step may have already been completed in a separate procedure unless your plastic surgeon is also the one removing your lesion or is working with your dermatological surgeon as a team in a single procedure.

If your plastic surgeon is the one excising the lesion, it will be done at this stage.

Mohs surgery is excision with immediate microscopic examination of the margins to determine that the cancer is completely removed.

Sometimes further excision and microscopic examination are required after the first section is examined—this is repeated until it is clear that cancer has been removed with near 100% certainty.

Wound Closure

Your plastic surgeon might place your suture line to follow the natural creases and curves of your face as a way to minimize the appearance of your scar.

After Surgery

You will be observed for a while after your surgery has been completed, and then given instructions for returning home. You might be given a prescription for antibiotics to take at home, especially if you've had a flap procedure.

You will be given discharge instructions, including how to recognize an infection. You should call your surgeon if you develop a fever over 101 F, redness, pain, or discharge. If you're given antibiotics to take, make sure to finish the whole recommended dose, even if you don't have any signs of an infection.

One of the most important things you can do to reduce your chance of infection is to refrain from smoking, as smoking interferes with healing after plastic surgery.

Future Surgeries

It is important to note that for approximately 15% of people, reconstruction after skin cancer excision must be done in at least two stages, especially with certain types of flap techniques.

The first stage creates and repositions the flap, and the second stage “sections” or separates the flap from its original location and blood supply. After you recover from the first step and blood supply to the wound has been sufficiently established, a second surgery may need to be scheduled to complete reconstruction.

Surgeries other than a flap technique may also require further procedures in order to get the desired cosmetic effect.

More About Reconstructive Surgery

If you want to find out more about reconstructive surgery after skin cancer removal, including how it’s done, your options, and what happens after surgery, take a look at some before and after photos of reconstruction after skin cancer. It can be helpful to talk to your surgeon prior to your surgery about your expectations.

If you have a weak stomach when it comes to looking at medical photos, you may wish to skip this step—yet many people find it encouraging and comforting to see just how well facial features can be restored, even after significantly large skin cancers are removed.

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Article Sources
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  1. Bordianu A, Bobirca F. Facial skin cancer surgery under local anesthesia. J Med Life. 2018;11(3):231-237. doi:10.25122/jml-2018-0059

  2. Rosengren H, Heal CF, Buttner PG. Effect of a single prophylactic preoperative oral antibiotic dose on surgical site infection following complex dermatological procedures on the nose and ear: a prospective, randomised, controlled, double-blinded trial. BMJ Open. 2018;8(4):e020213. doi:10.1136/bmjopen-2017-020213

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