title: Periorbital Mohs reconstruction: characterization of tumor histology, anatomic location, and factors influencing postoperative complications.
abstract: BACKGROUND
  When addressing skin malignancies of the periorbita, it is important to limit the excision of healthy tissue and preserve normal anatomic features while minimizing complications.
  
  
  OBJECTIVE
  The aim of this study was to identify perioperative risk factors associated with postoperative complications in a single-surgeon cohort.
  
  
  METHODS
  This was a retrospective review of consecutive patients who underwent periorbital Mohs reconstruction by a single surgeon at a teaching institution from 2008 to 2012. Demographics, patient and tumor characteristics, reconstructive technique, and postoperative complications were reviewed. Multivariate logistic regression was performed to identify perioperative risk factors associated with postoperative complications.
  
  
  RESULTS
  A total of 135 patients met the inclusion criteria. Local tissue rearrangement was performed for 74% of reconstructions, followed by full-thickness skin graft (FTSG) (20%) and cheek rotational flap (6%). Complications occurred in 23% of reconstructions, and 19% of complications required secondary surgery. Two variables were significantly associated with primary complications (p < .05): FTSG (p = .0017) and lid graft donor site (p = .0006). Reconstruction of a multisubunit defect trended toward a significant association with complications (p = .1005).
  
  
  CONCLUSIONS
  Our results indicate that FTSG and lid graft, in particular, result in a higher overall rate of complications when controlling for defect size.
authors.affiliation: *Department of Surgery, Division of Plastic Surgery, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania; Departments of †Dermatology and ‡Ophthalmology, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania.
authors.forename: Brett
authors.initials: B
authors.lastname: Michelotti
authors.forename: Ryan
authors.initials: R
authors.lastname: Mathis
authors.forename: John
authors.initials: J
authors.lastname: Roberts
authors.forename: Christie
authors.initials: C
authors.lastname: Travelute
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Billingsley
authors.forename: Michael
authors.initials: M
authors.lastname: Wilkinson
mesh_terms: D002280:Basal Cell Carcinoma / Q000601:surgery*; D005153:Facial Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D015580:Mohs Surgery / Q000009:adverse effects / Q000379:methods; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D016038:Skin Transplantation / Q000009:adverse effects*; D013524:Surgical Flaps / Q000009:adverse effects*