Applications of Burowʼs Grafts in the Reconstruction of Mohs Micrographic Surgery Defects

BACKGROUNDSurgical defects in anatomically challenging locations, such as near free margins or crossing cosmetic subunits, may present reconstructive challenges to the dermatologic surgeon. For selected defects, Burowʼs grafts may produce functional and aesthetic results in a single operative session. OBJECTIVETo describe the applications of the Burowʼs graft technique for the repair of defects after Mohs micrographic surgery. METHODSAn institutional review board–approved retrospective database review of surgical defects repaired with Burowʼs grafting after Mohs micrographic surgery at the Medical University of South Carolina was performed. The general technique of Burowʼs grafting is described, emphasizing proper graft sizing and direction of tension vectors. Varying anatomic locations and defect types are presented, with site-specific considerations and operative photographs. RESULTSBurowʼs grafting provides ideal color and textural match, preserves subunit boundaries, results in a compact single-site wound, and may avoid complications of alternate repair choices. The tension vectors produced in closing the graftʼs harvest site may be designed to prevent distortion of free margins. Burowʼs grafting may be combined with hinge flaps to repair deep or avascular defects. CONCLUSIONBurowʼs grafts are reproducible, aesthetic, and useful reconstructive choices for a variety of surgical wounds.