D139. Aesthetic and Functional Outcomes following Reconstruction of Mohs Defects of the Lip: Analysis of 417 Cases

Abstract

PURPOSE: Vermilion lip defects secondary to Mohs micrographic surgery (MMS) present significant challenges to the reconstructive surgeon. The association of reconstructive method with aesthetic and functional outcomes of the lip remains uncertain. METHODS: A retrospective review of patients who underwent MMS involving the vermilion lip between 2008-2022 was performed. Outcomes assessed included satisfactory appearance and function within 12 months, as reported at postoperative visits, complications, and revisions. Patients were stratified by the proportion of vermilion lip excised. Outcomes were analyzed using multivariable logistic regressions adjusting for patient-associated factors and with Chi-square tests. RESULTS: Four hundred seventeen patients were included. The mean defect area was 3.1±5.0 cm2 with 9.6% (n=40) of patients with defects involving >25% of the vermilion lip. Fifty-eight percent (n=244) were reconstructed with advancement flaps, 26% (n=108) with island pedicle flaps, and 10% (n=43) underwent complex reconstruction. Median follow-up duration was 89 days. Aesthetic and functional outcomes did not differ between patients with <25% versus 26-50% of the vermilion excised. Patients with >50% vermilion excised were significantly less likely to have satisfactory function (63.6% vs 99.4%, p<.001) and appearance (50.0% vs 91.5%, p=.004). Involvement of >25% vermilion was predictive of increased complications [OR=4.2, 95% CI: (1.6-11.0)] and revisions [OR=3.8, 95% CI:(1.5-9.4)]. Reconstructive method was not associated with any effect on aesthetics or function. CONCLUSION: Large MMS defects of the vermilion remain challenging to treat and were associated with greater rates of impaired function, appearance, complications, and revisions. Reconstructive method was not associated with alterations in function or appearance.