DOI: 10.5176/2251-3833_GHC17.36
Authors: Hui-hsiu Chang, Hui-hsiu Chang, I-chun Lin
Abstract: Background: Total excision is the treatment of choice for basal cell carcinoma (BCC) found mostly on face. Skin graft reconstruction is widely applied for defects which cannot be repaired directly. Local flap reconstruction, a more challenging procedure than skin grafting, provides better cosmetic result. To improve the cosmetic outcomes, we look for factors predicting reconstruction needs for facial BCC defects, so as to provide clinical guide for patients to be transferred to reconstructive surgeons. Methods: This is a retrospective chart review study. In the year 2009-2013, a total of 82 BCCs were excised but only 62 BCCs were included in the study. Gender, age, tumor location, specimen diameter and defect closure method (direct repair vs. reconstruction) were collected per tumor. The association between risk factors and reconstruction odds were analyzed by logistic regression model. Results: Tumor location (nose, odds ratio = 12.61, 95{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465} CI = 2.49 to 63.82) and specimen width (odds ratio = 1.37, 95{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465} CI = 1.16 to 1.62) were significantly associated with reconstruction odds. With 3mm as the margin, reconstruction is predicted when nasal BCC exceeds 4mm and nonnasal BCC exceeds 13mm. Conclusions: Physicians not familiar with local flap reconstruction can avoid unnecessary skin grafting and refer patients with planned excision size larger than 10mm (4mm + 2*3mm) and 19mm (13mm + 2*3mm) respectively at the nasal and nonnasal areas to experienced facial reconstructive surgeons.
Keywords: basal cell carcinoma; facial reconstruction; logistic regresssion
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