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Mohs for the Nose: Reconstruction Session Sneak Peek With Anna Bar, MD, FACMS


Bar will share insight on foldover interpolated flaps for full thickness of nasal defects.

Classic and novel reconstruction and video demonstrations are full of technical pearls to better approach a range of nasal defects with different reconstructive options. Anna Bar, MD, FACMS, and professor at Oregon Health & Science University is 1 of 4 Mohs surgeons demonstrating techniques to enhance patient outcomes.

Bar shares insight on what attendees will learn from the session “Video Recon: Nose” on Thursday, May 4 from 2:00-3:00 PST. She also explains why ACMS is a fun meeting for her and the value of transparency and relationship building between clinicians practicing dermatologic care and Mohs surgeons.

Dermatology Times®: Tell us about your involvement in the Nose Reconstrction session.

Bar: At this meeting, I'll be talking about interpolated flaps—meaning the flaps that are a 2-stage flap. When we are constructing the nose for some bigger defects or some trickier locations, we have to use the 2-stage procedure to reconstruct the nose where we make the flap and leave it attached to the blood supply—whether that's forehead flap or a cheek-to-nose interpolation flap—and leave it attached for a time period before removing the attachment and allowing the flap to survive on its own. This is mostly used for very large defects of the nose, or defects where the full thickness, nose or ala is removed, where we fold the flaps over onto themselves to recreate the mucosal lining. It's also used for tricky locations like the rim of the nose, where there's not a lot of loose skin and you have to do something a little bit different. I do have a lot of cases like this. And the talk is going to be you know, mostly a lot of videos. So showing kind of different defects at different angles, and mostly videos in the reconstruction talk.

Dermatology Times: What are the opportunities for research in Mohs surgery?

Bar: Even within this little talk that I'm doing, there's a couple of opportunities for research. Number one, we don't know the ideal timing for taking down the flap. Sowe're researching that. I've taken down the flaps as early as 1 or 2 weeks when the classical training is taking them down at 3 weeks. So that's an area for more research. And another area, even within my talk, a lot of these flaps, I'm doing TXA at the time of surgery, tranexamic acid injections, to decrease the amount of bleeding that people have from the pedicle after surgery. We're working on that as well and researching the optimal effects of TXA and the timing and everything like that. So tons of opportunities for research, even within my little topic that I'm talking about.

Dermatology Times: Which sessions are you looking forward to at the 2023 ACMS Meeting?

Bar: I love all the video reconstruction sessions because I feel likethat's how I learn-just from watching other people do the surgery and explaining the video. I also like the high-risk skin cancer sessions. I likethe Mohs for melanoma sessions because we do a lot of that at OHSU. Andwe're 1 of the institutions that really have wanted to move that forward as well.The literature review to catch you up on some of the new literature is always really helpful.There's athere's a ton. All the sessions are good and it's really curated down to excellent, excellent sessions every time.

Dermatology Times: What should all clinicians providing dermatologic care know about Mohs surgery?

Bar: I think it's important to have a good 2-way communication. Occasionally, people come in for Mohs surgery, and we decide maybe Mohs surgery is not their optimal treatment. So, I always get back to the dermatologist about what we talked about. And you know what and why we decided. Sometimes, patients who really would like to have Mohs surgery—they've had other reasons in the past where their excisions always got positive margins or they just really wanted to have the best treatment. So we should also listen to their wishes. There are situations where we can do Mohs on melanoma, even invasive melanoma, because we do get a lot of patients with the ill-defined invasive melanoma that have ssentinel node biopsy, and then sent to us to clear their actual tumor. So I think it's important to have the, you know, good relationship with your referring dermatologist about the treatment plan because sometimes it's not straightforward. Sometimes it might change. Sometimes there are, you know, exceptions to be made for certain conditions.

Dermatology Times: What keeps you coming back to the ACMS Annual Meeting?

Bar: I love this meeting because it'srelatively small, usually like 1200 people so it'svery easy to find the speakers. You know, talk to everybody asked questions that you don't normally get to ask and a 12,000 person meeting and you know, there'sthere's fewer competing sessions so feels a little bit less overwhelming, less walking, you know, we're all right there in the same hotel. Soit's a really fun meeting and this year, I don't even have to fly there. So it's pretty amazing-just hop on I-5!

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