Are Prophylactic Antibiotics After Nasal Mohs Reconstructions Necessary?

Introduction: Routinely prescribing antibiotics after Mohs reconstructions has increased in recent years, despite reportedly low rates of post-procedural infections. This is particularly favored for areas in close proximity to non-sterile sites, such as the nose, yet few studies have examined this practice pattern and its benefit for preventing complications.

Methods: Retrospective study of adult patients receiving Mohs nasal defect reconstructions at a single tertiary care center between January 2021 and December 2022. Collected data included patient demographics, medical history, surgical details (e.g., nasal subsite, cartilage exposure, reconstruction technique), post-procedural prophylactic antibiotics, post-procedural complications (e.g., infection, flap failure, wound dehiscence), and functional and cosmetic outcomes (measured via the Standardized Nasal Cosmesis and Heath Nasal Outcomes Survey).

Results: A total of 252 patients underwent nasal Mohs reconstructions during the study period, of which 54% were female and mean age was 70.2 years. The most common subsites were nasal tip (29.6%) and lateral nasal ala (29.1%). Mean defect depth was 3.52 mm, and 38.7% of patients had exposed cartilage or bone. The majority of reconstructions involved a local flap (58.0%), followed by interpolated flap (25.6%), and 33.7% required a cartilage graft. Most patients (70.2%) were prescribed post-procedural prophylactic antibiotics, typically cephalexin for 3 or 7 days. Post-procedural complications were documented in 19.1% of patients, with local skin erythema or inflammatory reaction being the most common (91.7%). The rate of complications and patient functional outcomes did not differ based on antibiotics use. Current analysis is ongoing to evaluate additional patient factors associated with postoperative infections and complications, including age, smoking status, location of defect, flap type, and in-clinic versus operating room procedures.

Conclusions: Prophylactic antibiotics after nasal Mohs reconstructions did not affect rate of complications or patient aesthetic or functional outcomes.