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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Mohs micrographic surgery &#40;MMS&#41; is considered the treatment of choice for skin cancer in at-risk skin areas or when the lesion is clinically poorly defined&#44; as it provides cure rates higher than those of other therapeutic options and minimizes the removal of healthy peritumoral tissue<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; In Spain&#44; the tumor most commonly operated using MMS is basal cell carcinoma&#44; followed by squamous cell carcinoma&#59; the most commonly used techniques are frozen-section MMS and flap reconstruction<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46; Nevertheless&#44; reconstruction of the defects caused by MMS often requires the use of different types of graft&#44; the course of which may be affected by different factors&#44; such as the size of the defect&#44; sex&#44; and time between surgery and repair of the defect&#46; In fact&#44; same-day reconstruction of the defect is not always possible&#44; and a delaying reconstruction can benefit planning of the surgery&#44; viability of the surgical bed&#44; and blood supply to the wound margins&#46; Some authors therefore recommend delayed reconstruction of those defects to improve graft survival&#44; although the consequences of delaying the reconstruction technique are not yet fully understood&#46; Delayed reconstruction is usual in tumors that require a delayed histologic evaluation of tissue samples fixed in formalin and set in paraffin&#46; This is the case of squamous cell carcinoma&#44; in which immune staining is required&#44; essentially to rule out perineural infiltration&#44; which is not uncommon&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">In the debate on same-day or delayed reconstruction following MMS&#44; 3 studies were recently published that analyze the rates of complications in patients who underwent delayed reconstruction after MMS with differing points of view<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a>&#46; One article links the delay in reconstruction to a higher number of postoperative complications&#44; although this study includes a smaller number of analyzed defects<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#44; whereas the other 2 articles found that delayed reconstruction was associated with a lower rate of postoperative complications<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Patel et al<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> performed a retrospective study of the postoperative complications of 342 patients in whom reconstruction of the defect following MMS was delayed for more than 24 hours&#46; The authors found that a delay of more than 2 days was associated with an increase in complications&#44; mainly infections&#46; Nevertheless&#44; only 4&#46;5&#37; of the defects were repaired with this much delay&#44; and most delays were associated with more complex cases and larger defects&#46; Thus&#44; a higher rate of complications may be due to the characteristics of the defect and not to the length of delay in performing the reconstruction&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Miller et al<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> performed a retrospective study of 633 defects repaired after MMS in 591 patients and found no link between the time to repair following MMS and surgical complications&#46; The variables associated with increased postoperative risk were smoking&#44; larger size and thickness of the defect&#44; and the use of composite grafts&#44; basically those that included cartilaginous tissue&#46; Similarly&#44; David et al<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> evaluated the results of the reconstruction of 320 defects following MMS using total skin grafts or composite grafts&#46; The mean interval for reconstructive surgery was 4&#46;7 days&#46; After performing a logistic regression analysis&#44; those authors showed that late repair &#40;defined as a delay of more than 6 days before reconstruction&#41; had a protective effect against postoperative complications&#46; Factors for a poor outcome found in that study were male sex and a larger defect size&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion&#44; delayed reconstruction after MMS may be linked to a lower rate of postoperative complications and may therefore be especially recommended when the risk of complications is higher&#44; such as in smokers&#44; in large defects&#44; or when composite grafts are used&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Funding</span><p id="par0030" class="elsevierStylePara elsevierViewall">This study has not received funding of any kind&#46;</p></span></span>"
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Resident's Forum
RF - Mohs Micrographic Surgery: Same-Day or Delayed Reconstruction?
FR - Cirugía micrográfica de Mohs. ¿Cierre inmediato o cierre diferido?
T. Montero-Vilchez
Autor para correspondencia
dramonterovilchez@gmail.com

Corresponding author.
, A. Rodriguez-Tejero, J. Tercedor-Sanchez
Servicio de Dermatología, Hospital Universitario Virgen de las Nieves, Granada, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Mohs micrographic surgery &#40;MMS&#41; is considered the treatment of choice for skin cancer in at-risk skin areas or when the lesion is clinically poorly defined&#44; as it provides cure rates higher than those of other therapeutic options and minimizes the removal of healthy peritumoral tissue<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; In Spain&#44; the tumor most commonly operated using MMS is basal cell carcinoma&#44; followed by squamous cell carcinoma&#59; the most commonly used techniques are frozen-section MMS and flap reconstruction<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46; Nevertheless&#44; reconstruction of the defects caused by MMS often requires the use of different types of graft&#44; the course of which may be affected by different factors&#44; such as the size of the defect&#44; sex&#44; and time between surgery and repair of the defect&#46; In fact&#44; same-day reconstruction of the defect is not always possible&#44; and a delaying reconstruction can benefit planning of the surgery&#44; viability of the surgical bed&#44; and blood supply to the wound margins&#46; Some authors therefore recommend delayed reconstruction of those defects to improve graft survival&#44; although the consequences of delaying the reconstruction technique are not yet fully understood&#46; Delayed reconstruction is usual in tumors that require a delayed histologic evaluation of tissue samples fixed in formalin and set in paraffin&#46; This is the case of squamous cell carcinoma&#44; in which immune staining is required&#44; essentially to rule out perineural infiltration&#44; which is not uncommon&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">In the debate on same-day or delayed reconstruction following MMS&#44; 3 studies were recently published that analyze the rates of complications in patients who underwent delayed reconstruction after MMS with differing points of view<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a>&#46; One article links the delay in reconstruction to a higher number of postoperative complications&#44; although this study includes a smaller number of analyzed defects<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#44; whereas the other 2 articles found that delayed reconstruction was associated with a lower rate of postoperative complications<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Patel et al<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> performed a retrospective study of the postoperative complications of 342 patients in whom reconstruction of the defect following MMS was delayed for more than 24 hours&#46; The authors found that a delay of more than 2 days was associated with an increase in complications&#44; mainly infections&#46; Nevertheless&#44; only 4&#46;5&#37; of the defects were repaired with this much delay&#44; and most delays were associated with more complex cases and larger defects&#46; Thus&#44; a higher rate of complications may be due to the characteristics of the defect and not to the length of delay in performing the reconstruction&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Miller et al<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> performed a retrospective study of 633 defects repaired after MMS in 591 patients and found no link between the time to repair following MMS and surgical complications&#46; The variables associated with increased postoperative risk were smoking&#44; larger size and thickness of the defect&#44; and the use of composite grafts&#44; basically those that included cartilaginous tissue&#46; Similarly&#44; David et al<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> evaluated the results of the reconstruction of 320 defects following MMS using total skin grafts or composite grafts&#46; The mean interval for reconstructive surgery was 4&#46;7 days&#46; After performing a logistic regression analysis&#44; those authors showed that late repair &#40;defined as a delay of more than 6 days before reconstruction&#41; had a protective effect against postoperative complications&#46; Factors for a poor outcome found in that study were male sex and a larger defect size&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion&#44; delayed reconstruction after MMS may be linked to a lower rate of postoperative complications and may therefore be especially recommended when the risk of complications is higher&#44; such as in smokers&#44; in large defects&#44; or when composite grafts are used&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Funding</span><p id="par0030" class="elsevierStylePara elsevierViewall">This study has not received funding of any kind&#46;</p></span></span>"
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