Facial Mohs Reconstruction

James F. Thornton, MD

This will be the welcomed opportunity to serve as an editor for a third Thieme Publication in addition to Thieme textbooks, all on Mohs reconstruction. Although this addition is similar to previous editions with description of lip, scalp, nose, cheek, and eyelid reconstruction, it also serves as a consideration of future directions in the care of these patients.

After every case I have done since residency, I have drawn a sketch of the repair and kept a single sheet standardized record of patient details. These serve as my patient database across many iterations of electronic record keeping. Last summer I had a student count the sheets (cases) and he reached 14,000. Any rational surgeon that performs 14,000 cases should spend some time reflecting on what was done and what could be better. My conclusion was that, with the exceptions of complete lip, nasal, or multisubunit midfacial defects, reasonable options were available for the majority of current facial reconstructive issues. Admittedly, one has frequently performed 14th-century surgery in 2018, but most end points are attainable.

Looking ahead, I would like to see more advances in biologics for assisted wound healing, as well as advances in tissue transplantation. But most importantly, from the patient health standpoint, significantly more attention could be paid to the identification as well as prevention of skin cancer across all socioeconomic categories, which will only occur with more equal access to health care for our patient populations, as well as significantly more attention directed to overall dietary improvements and overall patient health. Additionally, more finely attuned patient selection and restraint in certain patient populations with regard to skin cancer resection will probably provide the greatest benefits to patient quality of life overall.