Resident Physician Washington University in St. Louis Washington University in St. Louis, Missouri
Background: Several known factors affect outcomes of Mohs facial defect reconstruction; however, the effect of repair timing on outcomes is ill-defined.
Objectives: To determine the rates of postoperative complications between immediate and delayed repair of Mohs facial defects.
Design/Methods: The Preferred Reporting Items of Systematic Reviews and Meta-Analyses guidelines were used. Articles were selected using PICO format: population was Mohs facial defect patients, intervention was defect repair, comparator was immediate (<24 hours) or delayed (>24 hours) repair, outcome was complication rate. PubMed/Medline (1946-2020), EMBASE (1947-2020), Scopus (1823-2020), Web of Science (1900-2020), Cochrane Library, and Clinicaltrials.gov were searched. Two independent reviewers screened abstracts, and those in English with human subjects reporting on repair timing and complication rates were included.
Results: Search criteria yielded 6649 abstracts, 233 qualified for review. Data were gathered from only five studies; they alone contained comparative immediate and delayed repair data. Partial or total necrosis and wound healing issues were the only consistent outcomes measured in articles also reporting timing. Heterogeneity for both outcomes was high (I2=83.2% and 95.3%, respectively). Random effect model pooled results showed insignificantly higher rates of necrosis (Rate difference=0.07; 95% CI: -0.13 to 0.26; p=0.51) and wound healing issues (Rate difference=0.33; 95% CI: -0.27 to 0.93; p=0.29) in immediate repair.
Conclusions: The results suggest a small, insignificant trend toward increased rates of necrosis and wound healing issues in immediate repair of Mohs defects. Clinically important differences may exist, but small study numbers and large heterogeneity limit definitive conclusions and more studies are needed.