This review provides a comprehensive presentation of the evidence available in facial reconstruction post-Mohs Micrographic Surgery. Given the large diversity in post-Mohs reconstruction, there are limited guidelines in the management of defects. The aim of the present work is to provide a review of the best evidence as it pertains to several considerations in facial reconstruction. Data suggests that Mohs Micrographic Surgery and many reconstructive procedures can be performed as outpatient procedures under local anesthesia, with narcotic pain medication only given in certain patient populations following a minority of reconstructive procedures. Perioperative and topical antibiotics are generally not indicated. Aspirin and Warfarin can generally be continued for most reconstructive procedures, but clopidogrel and novel anticoagulants may predispose to increased bleeding complications. Delayed reconstruction appears to be safe, although data is discordant on this topic. No specific wound closure technique or suture choice appears to be consistently superior. Given the lack of robust comparative studies, consistent methodology, and variable defect sizes/ locations, no robust evidence-based guidelines can be generated for reconstruction techniques of facial subsites.
Preservation rhinoplasty encompasses a number of techniques that minimize disruption of the native cartilaginous and soft tissue nasal architecture. These techniques have gained popularity resulting in an increase in publications relevant to preservation rhinoplasty. However, many studies that present patient outcomes are of low-level evidence and do not incorporate validated patient-reported outcome measures. While these studies do consistently report positive outcomes, there are few high-level comparative studies that support the theoretical benefits of preservation relative to structural rhinoplasty. As contemporary preservation rhinoplasty techniques will continue to evolve and become incorporated into clinical practice, there will be the need for parallel emphasis on robust clinical studies to delineate the value of these methods.
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