Safety of the Use of Interpolation Flaps in Combination With Random Pattern Flaps or Skin Grafts for Repair of Post-Mohs Surgical Defects: A Cohort Study

BACKGROUND: Reconstruction after Mohs micrographic surgery (MMS) for large or complex defects may require combination techniques, including interpolated flaps plus local flaps and/or skin grafts. Outcomes after combination repairs are not well-characterized. OBJECTIVE: To assess postoperative complications associated with combination repairs using interpolation flaps with local flaps or full-thickness skin grafts (FTSG). METHODS AND MATERIALS: A single-center retrospective review of patients who underwent MMS with reconstruction using an interpolated flap plus a local flap and/or skin graft from January 1, 2018, to August 1, 2025, was performed. Demographic, tumor, and reconstructive data were collected. Primary outcomes included postoperative complications within 3 months. RESULTS: Twenty-one patients met inclusion criteria. The most common combination repair was a cheek-to-nose interpolation flap plus a local flap. Pain requiring prescription analgesia occurred in 23.81% of patients. Three patients (14.29%) experienced partial (2) or total (1) flap necrosis. Infection rate was 9.52% (2/21). No bleeding, dehiscence, hospitalizations, or emergency visits were observed. CONCLUSION: Combination reconstruction seems safe in the outpatient setting with low rates of major complications, supporting its use for complex defects while emphasizing counseling regarding pain and flap viability.