Hi Alyssa,

Thanks for your question. Other colleagues might have additional thoughts, but upon looking at published literature, it seems that the vast majority of studies on Mohs outcomes has been published by dermatologists. There is some information on healing rates observed at wound clinics, however they are scarce when compared to data published by dermatology. One of the reasons could stem from the reimbursement model around Mohs surgery.

More specifically, global periods (at least in the US). The codes for reporting Mohs procedures have zero global days; if the Mohs physician also performs the medically necessary repair, global days may apply to the repair codes. (All simple, intermediate and complex repairs have 10 days global period. All adjacent tissue transfers/rearrangements and grafts have 90 days global period.) That means that if a patient is healing by secondary intention and is asked to return to the office on the next day, the practice can charge for the e/m visit. Also, during the global period, follow up visits are included in the payment for the original procedure (e.g. wound repair). If a patient was operated by Dermatology and is asked to be followed up at a wound clinic, proper transfer of care needs to happen. If transfer of care is not properly documented and claims are not adjusted to reflect transfer of care, the program can become a target for audit and denials. For more information, see WoundReference topic "Global Surgical Transfer of Care to the Wound Clinic" (https://woundreference.com/app/topic?id=global-surgical-transfer-of-care-to-the-wound-clinic)

Having said the above, here is some information on published studies: 

>>Follow up at wound clinics: 

- 4 patient case series of biopsy-proven BCC from lower-extremity ulcers of patients who presented at a multispecialty wound clinic. All of the lesions were surgically excised, followed by split-thickness skin graft (n = 2) or healing by secondary intention (n = 2). All of the patients remained healed at follow-up ranging from 15 to 27 months, except for 1 patient who opted for conservative management and had not completely healed at 14 months'. (https://pubmed.ncbi.nlm.nih.gov/29438147/)
- 3 patient case series of patients that underwent Mohs, then wound bed preparation, followed by a microautografting procedure. Graft adherence occurred at the first dressing change and complete wound closure usually occurred within 4 to 6 weeks. This report was industry sponsored (https://www.hmpgloballearningnetwork.com/site/wmp/article/pearls-practice-closing-wounds-resulting-cancer-removal-under-local-anesthesia-using-micro)
- This article does not report original results but talks about interprofessional practice and care team collaboration related to Mohs  https://journals.lww.com/aswcjournal/Fulltext/2016/11000/Mohs_Surgery__Wound_Care_Considerations.1.aspx

>> Follow up by dermatology (recently published by dermatologists, in 2022)

- Adverse events associated with mohs micrographic surgery: multicenter prospective cohort study of 20,821 cases at 23 centers. Among 20 821 MMS procedures, 149 adverse events (0.72%), including 4 serious events (0.02%), and no deaths were reported. Among the 149 adverse events, common adverse events reported were infections (61.1%), dehiscence and partial or full necrosis (20.1%), and bleeding and hematoma (15.4%). Most bleeding and wound-healing complications occurred in patients receiving anticoagulation therapy. Use of some antiseptics and antibiotics and sterile gloves during MMS were associated with modest reduction of risk for adverse events. (https://pubmed.ncbi.nlm.nih.gov/24080866/)
- Second-Intention Healing in Mohs Micrographic Surgery: A Single-Center Academic Experience : Providers used secondary intention healing (SIH) in 22% of all MMS cases (n = 159/718). It was most commonly used for defects located on the nose, ear, temple, and periocular region. The average defect size and number of MMS stages for tumor clearance were 1.3 cm and 1.5 stages, respectively. Overall, low rates of postoperative complications were observed, and 95% of patients reported optimal or acceptable levels of satisfaction. (https://pubmed.ncbi.nlm.nih.gov/35723956/)
- Prevalence of wound complications following Mohs micrographic surgery (MMS): a cross-sectional study of 1000 patients undergoing MMS and wound repair in a UK teaching hospital.  In total, 1000 Mohs surgeries were performed on 803 patients, resulting in 1067 excisions. Complication rates in our cohort were low (minor 3.6%, intermediate 3.1% and major 0.8%) Potential risk factors for developing a complication included skin graft (unadjusted OR = 4.89, 95% CI 1.93-12.39; fully adjusted OR = 7.13, 95% CI 2.26-22.45) and patients undergoing surgery on the forehead (unadjusted OR = 3.32, 95% CI 0.95-11.58; fully adjusted OR = 5.34, 95% CI 1.40-20.42). Patients whose wounds were allowed to heal by secondary intention healing (6.8%) exhibited no complications. (https://pubmed.ncbi.nlm.nih.gov/35490302/)

Will continue to keep an eye out for any other studies, for now hope this helps