OSCE — choose a safe repair for a post-Mohs facial defect

Brief (to candidate)

Post-Mohs defect on the distal nose in a smoker. In 8 minutes, explain flap vs graft, offer a ladder of options including bilobed flap, state graft-take phases, and manage haematoma risk.

Candidate instructions

1. Confirm margins clear before complex cover.
2. Define flap vs graft.
3. Offer at least three repair options with pros/cons.
4. Recite imbibition → inosculation → neovascularisation.
5. State urgent action for expanding haematoma.

Examiner checklist (mark each domain / 10)

Model key actions

• Match repair to subunit and depth, not ego.
• Immobilise grafts (bolster optional per evidence, immobilisation required in principle).^[4]

Common errors

• Designing a high-tension random flap tip on a smoker without alternative.
• Reconstructing before margins known.
• Ignoring free-margin ectropion/nasal valve risk.