Delayed full-thickness skin grafts revisited.

Background: There are many options for the management of surgical defects after Mohs micrographic surgery (MMS). For patients with complex defects who are not candidates for immediate grafting or who lack appropriate donor skin for a flap or who do not desire to undergo a major flap procedure, delayed full-thickness skin grafting (FTSG) may be an option.

Objective: To determine the role and usefulness of delayed FTSG in the management of Mohs surgical defects.

Methods: The records of 70 patients, seen over a 5-year period, who had their Mohs surgical defects repaired with a FTSG or who were scheduled for a delayed FTSG, were reviewed, along with their accompanying photographs (when available). The outcome of immediate and delayed FTSG was compared in terms of (1) graft loss, (2) epidermal sloughing, (3) thickening and/or irregularity, (4) contour correction, (5) hypopigmentation/hyperpigmentation, (6) persistent erythema, and (7) need for surgical revision.

Results: Twenty-seven patients underwent immediate FTSG, and 20 patients underwent delayed FTSG on an average 3.6 weeks after Mohs surgery. Twenty patients, originally scheduled for a delayed FTSG, were allowed to heal by second intention, with a very satisfactory cosmetic result in most instances. When patients undergoing immediate FTSG were compared with those undergoing delayed FTSG, there was essentially no difference in the two groups, as judged by the parameters cited previously here.

Conclusions: Delayed skin grafting is often a viable option for patients undergoing Mohs surgery who are not candidates for immediate FTSG or who lack appropriate donor skin for a flap or who do not desire a major flap repair. It also has the added advantage in that as these patients are monitored in preparation for delayed grafting, it quite often becomes obvious that a significant proportion (more than 50%) can be allowed to heal by second intention with a satisfactory cosmetic result.