Face Repair and Reconstruction after Mohs or Injury
Following Injury (trauma, burn,..) or when the final stage of Mohs Micrographic Surgery is found to be free of tumor, you are left with a defect. The next phase of your procedure is the skin reconstruction. The reconstruction phase is where facial plastic surgeons can differ significantly in their approach and final results. Dr. Simoni is an expert at skin reconstruction, especially of the nose, ears, lips, and facial defects, and will utilize highly advanced reconstruction techniques to provide a natural cosmetic result with minimal to no visible scarring.
Dr. Simoni offers five options for the repair of the facial defect: 1. allow the defect to heal in on its own; 2. close the defect in a straight line; 3. utilize a flap closure; 4. utilize a graft closure; and 5. utilize a combination of 1 though 4. A flap repair involves the mobilization and stretching of tissue adjacent to the defect. A graft consists of the removal of skin from a distant site (i.e. in front or behind the ear) and replacing it over the defect. Unlike other reconstructive surgeons, Dr. Simoni relies primarily on unique flap reconstructions to provide the best cosmetic result. Adjacent skin used in the flap repair matches the thickness, color, and texture of the missing skin, whereas the graft skin removed from another facial area will not match exactly in thickness, color, or texture. Allowing the defect to heal without reconstruction can take 3 to 12 weeks of daily wound care and produce unpredictable scarring ranging from excellent to an unacceptable cosmetic result.
Dr. Simoni favors flap reconstruction with suture removal after one week with a predictable scar over allowing the defects to heal in on their own. Linear closure is preferable in certain facial regions, however flap repairs that create broken and geometric scars (Z-shaped, L-shaped) provide a superior cosmetic result. Linear scars that cross facial creases are much more obvious than broken lines and are more likely to spread over time.
Another important component of advanced reconstructive surgery is the meticulous suturing of the skin. Dr. Simoni emphasizes the use of buried or subcutaneous sutures in his closures. These buried sutures dissolve over a one to three month period and allow the skin edges to form a strong bond that will prevent delayed spreading of the scar (commonly seen in wounds closed with only top or superficial sutures). When placed properly, buried sutures will completely close the wound edges so that superficial sutures can be used to perfectly align the skin edges. Well-aligned skin edges seen on day one will result in a barely visible scar down the line. Since the wound tension is handled completely by the buried sutures, the top sutures can be removed in one week or less and will not cause the "railroad track" scars commonly seen with inferior stitching techniques. Scars typically heal over a 12 month period of time, however his suturing techniques can produce remarkable resolution of scars within six weeks or less.
Please note: These photos of surgical defects following Mohs Micrographic surgery are real and unaltered. Do not view them unless you are prepared to see graphic images including skin wounds and surgical procedures. The objectives of these slide shows are to introduce you to Dr. Simoni's unique facial reconstruction procedures and provide you with a greater understanding of the final results that he can achieve despite significant tissue loss.
These cases do not represent the typical, small, and simple reconstructions representative of the majority of Mohs surgery patients. Instead, they illustrate some of the larger defects and more advanced and proprietary reconstruction techniques. They do not necessarily represent your skin cancer, defect diameter or depth, or the reconstruction choice and outcome.