title: Repair of a large wound of the back, post-Mohs micrographical excision, using chronic skin expansion.
abstract: BACKGROUND
  Large defects not otherwise closed primarily may be closed after chronic skin expansion.
  
  
  OBJECTIVE
  If chronic expansion were deemed indicated for the closure of a proposed defect expected to result from Mohs micrographic surgery, can it be performed before Mohs surgery, avoiding the increased chance of expander extrusion via the defect when done postoperatively?
  
  
  METHODS
  A team approach of a Mohs surgeon and a plastic surgeon coordinated scheduling an insertion of and staged infiltration of a tissue expander before Mohs surgical removal of a large basal cell carcinoma on the back of a young woman. The reconstruction after Mohs surgery was scheduled for the immediate postoperative period.
  
  
  RESULTS
  The Mohs surgery completed removed the carcinoma, and the expander was removed, enabling the surgeon to perform a side-to-side closure.
  
  
  CONCLUSIONS
  Provided that there is not a great probability of the neoplasm extending significantly deeper or wider than expected and that the skin expander is placed so as not to disturb the plane of Mohs excision, this is a useful technique to close large Mohs defects.
authors.affiliation: Department of Dermatology, The Mount Sinai Medical Center, New York, New York, USA. rsheltonmd@aol.com
authors.forename: Ron M
authors.initials: RM
authors.lastname: Shelton
authors.forename: Ted
authors.initials: T
authors.lastname: Chaglassian
mesh_terms: D000328:Adult; D001415:Back; D002280:Basal Cell Carcinoma / Q000601:surgery*; D062109:Dermatologic Surgical Procedures; D005260:Female; D006801:Humans; D015580:Mohs Surgery / Q000009:adverse effects; D012867:Skin / Q000293:injuries; D012878:Skin Neoplasms / Q000601:surgery*; D015626:Tissue Expansion; D015625:Tissue Expansion Devices; D014945:Wound Healing