Secondary Intention Healing After Mohs Surgical Excision as an Alternative to Surgical Repair

Abstract

Background A multitude of reconstructive options exist for patients after Mohs surgery of cutaneous neoplasms of the head and neck. Secondary intention healing is often overlooked and underused but has numerous advantages, including superior esthetic outcomes compared with surgical reconstruction for wounds that exhibit particular characteristics. The ability to predict cosmetic results based on wound characteristics can greatly help in the decision between surgical repair and secondary intention healing. Although other studies have discussed results after secondary intention healing on various areas of the head and neck, here, we specifically focus on cases of the nasal area. Methods We conducted a chart review of 37 patients with nasal reconstructions using secondary intention healing by a single surgeon over a 2-year period. Wound outcomes were graded as poor, acceptable, good, or excellent based on definitions found in the literature. Results We found that overall, the best cosmetic outcomes were associated with concave areas of the nose, such as the nasal ala and sidewall, and that superficial wounds healed better than deep wounds. Furthermore, we found that convex areas of the nose, such as the nasal tip, did not heal as well by secondary intention. However, if the wound was small and superficial enough, the wound still healed with a good to excellent cosmetic outcome. Conclusions Healing by secondary intention is a reasonable consideration for suitable wounds. The need for surgical scar revision is addressed, if necessary, after the wound has healed. The benefits of secondary intention healing include: Future studies will address a larger cohort size of patients with more varied skin types and ages, as these are characteristics that can influence cosmetic outcome. Furthermore, healed wounds continue to improve in appearance over time, and it would be worthwhile to monitor patients' cosmetic outcomes over a longer follow-up period.

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

“…Furthermore, it was also reassuring that no adverse events (AEs) were recorded in patients whose wounds were allowed to heal by SIH (Supplementary Table S2), supporting several studies that have shown that SIH can provide excellent cosmetic results. 10,11 Although SIH is not suitable for every wound defect, generally being reserved for concave anatomical locations, 12 these results should encourage general dermatologists performing skin surgery that SIH should not be overlooked for wound reconstruction.…”

Secondary Intention Healing of Nasal Ala and Tip Defects: A Simple and Valuable Treatment Option

“…9,10 For the nose, the best esthetic outcomes were seen in wounds located on the nasal ala, a concave surface, and poorer results were seen on the nasal tip, a convex surface. 7 Statistical evidence has also shown that concave areas of the face are prone to heal excellently, especially if these wounds are small, superficial, and located near the medial canthus and medial cheek. 6 Furthermore, on concave surfaces secondary intention healing produces cosmetic results that are superior to those produced by flaps or grafts.…”

“…The evaluation criteria referred to previous literatures. 6,7 Excellent was defined as a scar with no mismatch in edge contour and a good color match or only minor hypopigmentation to surrounding skin. Good was defined as little mismatch in edge contour and good color match or only minor hypopigmentation to surrounding skin.…”

Soft Tissue Trauma to the Nose: Management and Special Considerations

“…Areas that are prominent and convex (i.e., the nasal tip) should be repaired via other methods. 18,19 Other cited benefits include avoidance of further invasive procedures, lack of donor site morbidity, and this being a viable option for those who are not optimal surgical candidates for other reconstructive options. 18 This option may require diligent wound care and patience from the patient.…”

“…18,19 Other cited benefits include avoidance of further invasive procedures, lack of donor site morbidity, and this being a viable option for those who are not optimal surgical candidates for other reconstructive options. 18 This option may require diligent wound care and patience from the patient. There is also the possibility of hypopigmentation of the area, which may be more cosmetically unacceptable in higher Fitzgerald skin types.…”