practicaldermatology.com
Large cutaneous reconstructions performed under local anesthesia (including complex linear closures [CLCs], flaps, and grafts) are generally safe but have higher complication rates compared to smaller procedures, a recent study from the University of California, San Diego showed.
The retrospective analysis included 436 patients treated who underwent Mohs micrographic surgery between 2010 and 2022. Surgical defects were repaired using CLCs (≥12.5 cm), large flaps (≥30 cm²), or skin grafts (≥30 cm²).
The overall complication rate was 16.1%, with specific complications including infection (6.0%), bleeding (3.2%), hematoma (5.0%), seroma (0.2%), and necrosis (6.5%). There were no adverse effects from local anesthesia. Complication rates varied by reconstruction type: 17.9% for CLCs, 12.8% for flaps, and 35.8% for grafts. Contributing factors in complications like infection, hematoma, and necrosis included larger defect sizes, comorbidities, and immunosuppression. Graft necrosis affected 15.1% of patients and was most often associated with infection or hematoma.
"Collectively, our study contributes valuable insights into the complication rates and risk factors associated with different repair techniques after MMS, further informing clinical decision-making and patient care," the authors wrote. "Though these results are based on a relatively large sample size, the procedures were performed over a large time frame, and treatments were performed by multiple surgeons. Thus, treatment approaches may have varied, and these results may not be generalizable to all patients undergoing large reconstructions. Future research could incorporate larger sample sizes and incorporate a more comprehensive evaluation of treatment outcomes including cosmetic outcomes and quality of life."
Source: Nowsheen S, et al. Journal of Cutaneous Medicine and Surgery. 2025. Doi:10.1177/12034754251316297