Patient-reported and clinical outcomes of skin graft-based digital Mohs reconstructions

Background

Mohs resection of digital skin cancer permits digital salvage over amputation, but exposed bone in wounds presents a challenge to reconstruction. We evaluated single-stage and two-stage skin graft-based reconstruction techniques in terms of clinical and patient-reported outcomes.

Methods

A retrospective review was conducted of patients who received skin graft-based reconstruction following digital Mohs surgery between 2014 and 2021. Patient demographics, cancer information, and outcomes were analyzed. Outcomes included infection, seroma, hematoma, dehiscence, cyst formation, nail spicule, contracture, necrosis, graft failure, need for secondary amputation, reoperation, and recurrence. The PROMIS Upper Extremity patient-reported outcome instrument was used post-operatively. An intention-to-treat paradigm was used for analysis.

Results

Fifty reconstructions were included. Twenty-three reconstructions were single-stage (46%), and 27 reconstructions were two-stage (54%). There were no differences in preoperative demographics or comorbidities between those who had single or two-stage reconstructions. Patients with disrupted periosteum were more likely to have two-stage reconstruction (p < 0.05). Overall, there were no differences in postoperative complications or reoperations between single-stage and two-stage reconstructions (22.7% vs. 16.7%). Current smokers had a greater risk of postoperative contracture (p < 0.05). There was no difference in mean PROMIS T-score between single-stage and two-stage reconstructions. Patients with hypertension had worse postoperative PROMIS T-scores (p < 0.05).

Conclusions

Single-stage and two-stage skin graft reconstruction for digital skin cancer reconstruction appear to be equivalent in clinical and quality-of-life outcomes. Two-stage reconstruction is indicated for more complicated defects. Patient factors, such as smoking status, need to be considered for counseling on outcomes.