Comparison of Various Techniques in the Reconstruction of Mohs Chin Defects

Abstract

Introduction: Defects of the chin after Mohs resection of skin cancer are relatively uncommon yet technically challenging. This is due in part from the numerous topographic features and multiple soft-tissue components such as the underlying muscle layers, the well-defined submental crease, and the bony gonion, all of which contribute to the intricacy of the reconstruction. We review our results over an 11-year period to assess the most commonly used closure techniques and to provide a simplified algorithm for closure of chin defects. Materials and Methods: Retrospective chart review. Approval was obtained by the Institutional Review Board of the University of Texas Southwestern Medical Center for this retrospective medical chart review. All patients undergoing reconstruction of chin defects by the senior author (J.T.) following Mohs excisional chemosurgery from 2005–2013 were included. Pre- and postoperative photographs were reviewed in addition to defect size, location, operative technique, and postoperative complications. Photograph consent forms were obtained at the time of surgery. Patients were excluded if the defect involved the lower lip. One patient was excluded for incomplete data. Results: A total of 35 patients were identified over the period in question. There was a wide range with regard to patient age and race. Both sexes were operated on in roughly equal proportions. The average defect size was 4.29 cm (range, 2–15 cm). Linear closure was performed on 26 patients (72%). Other choices for repair included rhombic flaps (n = 3), submental perforator V to Y advancement flaps (n = 3), bilobed flap (n = 1), and rotational flap (n = 1). All patients achieved a good final aesthetic result with complete functional maintenance of the lower lip with no lower lip retractions. Scars were well healed by the second and third follow-up appointments. Conclusion: Optimal chin reconstruction, defined by successful wound closure, careful scar placement, and minimal postoperative complications, may be accomplished by taking advantage of the inherent characteristics of the chin. In most small defects of the chin, primary closure is attainable. In larger defects of the chin, recruitment of flaps from the cervical region is preferred, with preference toward submental island flaps when allowed.