National Trends in Repair Type Selection After Mohs Micrographic Surgery: A Benchmark Analysis Using TriNetX

Following histologic tumor clearance in Mohs micrographic surgery, reconstruction plays a critical role in patient outcomes. Despite its importance, national-level data on real-world reconstructive patterns by anatomic site are lacking. Characterize national repair patterns by anatomic site following Mohs micrographic surgery. Using the TriNetX research network, we extracted Mohs micrographic surgery cases performed between 2006 and 2024 (N = 607,214) and categorized repairs into reconstructive classes using CPT groupings. Cases were stratified by anatomic subunit using ICD-10 codes. Temporal trends and statistical significance were assessed using chi-squared tests. Our analysis revealed the following distribution of repair types across all sites: complex repairs (34%), no same day repair (19%), local flaps (19%), intermediate repairs (18%), skin grafts (8%), interpolation flaps (0.8%), island pedicle flaps (0.1%), and simple closures (1.0%). Utilization of island pedicle flaps and complex repairs declined significantly over time (P<0.0001), coinciding with CPT coding revisions, while intermediate repair use increased. Local flaps, skin grafts, and no same day repair remained relatively stable but trended downward over time. This study provides valuable insights for Mohs surgeons seeking to benchmark their own reconstructive practices as understanding one's practice patterns in relation to national norms is critical.