Ear Reconstruction after Mohs cancer excision: lessons learned from 327 consecutive cases
Abstract
BACKGROUND: The lips provide key functional and aesthetic features of the face. From social interactions and speech to swallowing and oral competence, a functional dynamic structure is required. This interaction with surrounding landmarks presents a challenge for reconstruction. There are a myriad of ways reported to reconstruct these defects; however, as the authors' practice has evolved, a more refined approach was developed to optimize results and minimize the complexity of each patient's surgery. METHODS: A retrospective review from 2004 to 2018 was performed of consecutive patients who underwent lip reconstruction following Mohs cancer resection performed by a single surgeon. Each case was evaluated for key patient characteristics, defect location, defect size, defect composition, reconstructive modality, and complications. In addition, the evolution of treatment types over those 14 years was evaluated. RESULTS: Six hundred fifteen patients underwent lip reconstruction. Defects most commonly involved the upper lateral lip, and 247 (40 percent) involved both the skin and vermillion. A significant majority of the patient's defects were repaired using either linear closure or V-wedge excision and closure. A complication rate of 10.2 percent (n = 63) was found, ranging from oral incompetence to cancer recurrence. There was no significant difference in complication rates in patients older than 75 years, in smokers, or in patients who were on anticoagulation. CONCLUSIONS: The authors' techniques have evolved from more invasive advancement and rotation flaps to a more reliable linear closure method over the past 14 years. This study shows that lip reconstruction is safe in elderly patients, smokers, and patients who are on anticoagulation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
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Osteointegrated prostheses, costochondral implants, or polyethylene Medpor implants are the preferred methods to reconstruct near-total to total ear defects.
“Osteointegrated prostheses, costochondral implants, or polyethylene Medpor (Stryker Corp., Kalamazoo, MI) implants are the preferred methods to reconstruct near-total to total ear defects.5,[34][35][36][37][38]”
From Ear Reconstruction following Mohs Micrographic Surgery (2024) · cites this paper as [5]
The present study demonstrated a variety of reconstruction options available for the auricular region, in addition to the frequent use of flaps and grafts, similarly to previous publications.
“The present study demonstrated the variety of reconstruction options available for the auricular region, in addition to the frequent use of flaps and grafts, similarly to previous publications.10, 11”
From Auricular reconstruction after Mohs micrographic surgery: analysis of 101 cases (2021) · cites this paper as [10]
With 0.99% infection and 6.93% minor complications (bleeding and partial graft necrosis), the authors' sample reproduces the types of adversities most often described in the literature.
“With 0.99% of infection and 6.93% of minor complications (bleeding and partial graft necrosis), the authors’ sample reproduces the types of adversities most often described in the literature.10, 19”
From Auricular reconstruction after Mohs micrographic surgery: analysis of 101 cases (2021) · cites this paper as [10]
Trephination can supply adequate vasculature in wound beds with exposed cartilage for the foundation and maintenance of FTSGs.
“Trephination can supply adequate vasculature in wound beds with exposed cartilage for the foundation and maintenance of FTSGs.5”
From Ear Reconstruction following Mohs Micrographic Surgery (2024) · cites this paper as [5]
The superior third of the helix and antihelix are the most common locations affected by malignancies including squamous cell carcinoma (SCC) and basal cell carcinoma.
“The superior third of the helix and antihelix are the most common locations affected by malignancies including squamous cell carcinoma (SCC) and basal cell carcinoma.5,6”
From Ear Reconstruction following Mohs Micrographic Surgery (2024) · cites this paper as [5]
For full-thickness defects closed primarily, a layered approach should be implemented to ensure optimal outcomes and to prevent perceivable stepoffs.
“For full-thickness defects closed primarily, a layered approach should be implemented to ensure optimal outcomes and to prevent perceivable stepoffs.5”
From Ear Reconstruction following Mohs Micrographic Surgery (2024) · cites this paper as [5]
Primary closure can frequently repair ear defects < 1 cm2 on the auricular rim.
“Primary closure can frequently repair ear defects < 1 cm 2 on the auricular rim. 5”
From Ear Reconstruction following Mohs Micrographic Surgery (2024) · cites this paper as [5]
The findings on complication rate are in line with the current literature.
“These findings are in line with the current literature on the topic [7,8,9].”
From A Retrospective Study on Single-Stage Reconstruction of the Ear following Skin Cancer Excision in Elderly Patients (2022) · cites this paper as [7]
Patients were evaluated at a minimum follow-up time of 12 months (mean 22 months).
“The patients were evaluated at a minimum follow-up time of 12 months.”
From A Retrospective Study on Single-Stage Reconstruction of the Ear following Skin Cancer Excision in Elderly Patients (2022) · cites this paper as [7]
Sanniec et al. found no statistically significant difference in complication rate in elderly patients compared with younger patients.
“Interestingly, Sanniec et al. found no statistically significant difference in complication rate in elderly patients compared with younger patients [7].”
From A Retrospective Study on Single-Stage Reconstruction of the Ear following Skin Cancer Excision in Elderly Patients (2022) · cites this paper as [7]
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Self-citationTreatment of Non-melanoma Skin Cancers in the Absence of Mohs Micrographic Surgery
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“found no statistically significant difference in complication rate in elderly patients compared with younger patients [7].”
BackgroundResultAuricular reconstruction after Mohs micrographic surgery: analysis of 101 cases
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“The present study demonstrated the variety of reconstruction options available for the auricular region, in addition to the frequent use of flaps and grafts, similarly to previous publications.(10,11) It also demonstrated that, differently from the nasal area, the auricular region allows the reconstruction of several…”
BackgroundResultLower Lip Reconstruction after Skin Cancer Excision: A Tailored Algorithm for Elderly Patients
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Gonzales, J. J., Hollier, P., & Hollier, L. H. (2026) · The Journal of craniofacial surgery (Print) · doi:10.1097/scs.0000000000012871
Tran, V. T. T., Myrdal, C. N., Wang, S., Valdés-Morales, K. L., Hunter, E., Sheikh, U., Raj, L. K., Richter, C., Lu, C., Chinniah, G., et al. (2026) · Journal of the American Academy of Dermatology · doi:10.1016/j.jaad.2026.05.094
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- Authors
- Sanniec, K., Harirah, M., & Thornton, J. F.
- Affiliations
- The University of Texas Southwestern Medical Center (US)
- ORCID
- Sanniec, Kyle
- Venue
- Plastic & Reconstructive Surgery
- Published
- 2019-09
- Volume
- 144
- Issue
- 3
- Pages
- 719-729
- ISSN
- 0032-1052 (ISSN-L)
- OpenAlex
- W2962962594
- Cited by
- 39
- References
- 59
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 8 · 2023: 5 · 2022: 5 · 2021: 6 · 2020: 4
- FWCI
- 3.58
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Plastic & Reconstructive Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Reconstructive Facial Surgery Techniques
- Health Sciences › Medicine › Surgery › Reconstructive Surgery and Microvascular Techniques
- Health Sciences › Medicine › Oncology › Ear and Head Tumors
- Keywords
- ear reconstruction, Mohs micrographic surgery, full-thickness skin graft, flap reconstruction, reconstruction complications, elderly patients, reconstruction algorithms
- MeSH terms
- Adipose Tissue, Adult, Aged, Aged, 80 and over, Ear, External, Female, Humans, Male, Middle Aged, Retrospective Studies, Skin Neoplasms, Surgical Flaps, Mohs Surgery, Logistic Models, Skin Transplantation, Plastic Surgery Procedures, Ear Auricle, Young Adult
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