Mohs surgery is a specialized and precise technique used for removing skin cancers, particularly those in visible or functionally important areas. While the removal of cancerous tissue is the primary goal, a common question arises regarding wound closure: does Mohs surgery always require stitches? The answer is nuanced; while stitches are frequently used, they are not the only method, nor are they always the preferred approach for wound closure following the procedure.
Understanding Mohs Surgical Process
Mohs micrographic surgery distinguishes itself through a meticulous layer-by-layer removal of cancerous tissue. After each thin layer of tissue is excised, it undergoes immediate microscopic examination by the Mohs surgeon, who also acts as a pathologist. This real-time analysis ensures that all cancerous cells are identified and removed, while simultaneously preserving the maximum amount of surrounding healthy tissue. The precision of this technique means that the resulting surgical wound, or defect, is often as small as possible, directly reflecting the exact extent of the cancer.
Closure Options After Mohs
After the Mohs surgeon confirms all cancerous cells have been removed, various methods can be employed to close the resulting wound. Primary closure is a common approach where skin edges are brought together and stitched directly. This method often uses both dissolvable sutures (absorbed by the body) and non-dissolvable sutures (requiring later removal). It is preferred when wound edges can be easily approximated without tension.
Sometimes, a wound is left to heal by secondary intention, meaning it is not stitched closed. Instead, it heals naturally from the bottom up as new tissue forms. This method is chosen for certain body locations, such as concave facial areas (e.g., inner corner of the eye, ear), where cosmetic outcomes can be excellent, or if infection is a concern. The wound is covered with a dressing changed regularly to promote a moist healing environment.
For larger or more complex defects, reconstructive techniques like skin flaps or skin grafts are necessary. A skin flap involves moving adjacent healthy skin and underlying tissue to cover the wound, maintaining its blood supply. A skin graft involves transplanting a thin piece of skin from a donor site elsewhere on the body to cover the surgical defect. These complex closures are reserved for extensive excisions where primary closure or secondary intention healing would not yield optimal functional or aesthetic results.
Factors Influencing Closure Choice
Closure method choice after Mohs surgery depends on several factors. Wound characteristics, including size, depth, and anatomical location, significantly influence the approach. For instance, wounds on mobile areas like joints or areas with limited skin laxity require different considerations than those on the trunk.
Patient-specific factors also play a substantial role. A patient’s age, overall health, skin elasticity, and pre-existing medical conditions impact healing and the chosen closure method. Surgeons also consider desired aesthetic outcome and function preservation, particularly for procedures on the face, hands, or feet. Infection risk and patient lifestyle, such as activity level during healing, are also evaluated for appropriate wound management.
Post-Procedure Care and Healing
Post-procedure care varies based on the chosen closure method. Regardless of the technique, keeping the wound clean and dry is emphasized, often involving regular dressing changes. For stitched wounds, specific instructions are provided regarding suture care and removal timeline, typically within one to three weeks. Patients are also advised on infection signs to monitor, such as increased redness, swelling, pus, or warmth.
For wounds healing by secondary intention, detailed open wound care instructions are provided, including specific dressing materials and techniques to encourage granulation tissue formation. Complex closures, such as flaps or grafts, require more specialized care, including trauma protection and close monitoring of blood supply to the relocated tissue. Overall healing varies significantly based on wound size, location, and individual healing capacity, ranging from weeks for smaller wounds to months for larger reconstructions.